Effects of functional differentiation within home care on the quality of care--from the client's viewpoint

In home care nursing work is redesigned by differentiated practice (= skill mix) and specialization. The aim of this redesign is efficient use of staff, and maintenance or improvement of quality of care. In this article the effects of differentiated practice and specialization are studied in respect of quality of care. The perspective of the client was taken as the starting point. Quality of care was defined as the discrepancy between clients' expectations and perceptions of several aspects of care. The effects of work redesign were determined on the basis of a comparison between an experimental (n = 103) and a control group (n = 108). Data-analysis showed hardly any differences. Possible explanations are the premature status of the projects and the fact that clients are usually (very) satisfied. The margin in which differences between the experimental and the control group should occur is therefore very small. However, by means of this approach a detailed picture can be obtained of the subjective standard clients use to judge the quality of care.     

The impact of organizational downsizing on the job satisfaction of nurses

Professional nurses across Canada are being affected by health reform initiatives designed to deinstitutionalize the health care system. This panel study examined the impact this restructuring has had on nurses' overall job satisfaction as well as their satisfaction with various aspects of their job and work environment. The participants consisted of 345 nurses employed in 3 community hospitals in southwestern Ontario. Hospital downsizing had relatively little effect on overall job satisfaction, satisfaction with kind of work, amount of work, and physical work conditions. However, compared to before the downsizing, nurses reported a significant deterioration in satisfaction with their career future, hospital identification, supervision, and co-workers following the implementation of restructuring initiatives. We discuss the organizational and management implications of these findings and suggest ways that hospital administrators can minimize the negative effects of downsizing on nursing professionals.     

The correspondence of patient satisfaction and nurse burnout

This study examined the relationships of nurse burnout, intention to quit, and meaningfulness of work as assessed on a staff survey with patient satisfaction with nursing care, physician care, information provided and coordination of care, and outcomes of the hospital stay assessed post-discharge. Sixteen inpatient units from two hospital sites formed the data base and included 605 patients and 711 nurses. Patients' perceptions of the quality of each of the four care dimensions corresponded to the relationships nurses had with their work. Patients on units where nurses found their work meaningful were more satisfied with all aspects of their hospital stay. Patients who stayed on units where nursing staff felt more exhausted or more frequently expressed the intention to quit were less satisfied with the various components of their care. Although nurse cynicism was reflected in lower patient satisfaction with interactions with nursing staff, the correlations between cynicism and other aspects of care fell below statistical significance. No significant correlations were found between nurse professional efficacy and any of the patient satisfaction components measured. The implications of the relationship between patient satisfaction and nurses' perception of their work is discussed.     

Organizational and individual factors influencing job satisfaction and burnout of mental health workers

Job satisfaction and burnout are important areas of study because of the financial and social effects of job satisfaction and the damaging physical/psychological impacts of burnout. Two hundred family/children and psychiatric workers of seven social service organizations were surveyed. Instruments used were the Minnesota Satisfaction Questionnaire, the Maslach Burnout Inventory, and the Staff Burnout Scale for Health Professionals. Reported levels of job satisfaction and burnout are within normal limits. Psychiatric and family/children workers report equal job satisfaction levels, but the latter group reports significantly higher burnout levels. Both groups are particularly satisfied with the amount of praise delivered by supervisors and are reportedly dissatisfied with salary levels and promotional opportunities. These three factors are strongly associated with job satisfaction and burnout levels of both groups. Findings have practical implications for social service administrators and practitioners. Correlates of satisfaction and burnout can be altered in order to maintain employee satisfaction and reduce burnout, absenteeism and turnover.     

Burnout and coping in human service practitioners.

Do many Spanish human service practitioners suffer from burnout? What coping strategies are used to combat work stress, and are they associated with lower burnout? Which strategies may the psychologist promote to improve organizations? With an eye toward helping organizations improve their workers' quality of work life and service delivery, 211 professionals, either child protection workers or in-home caregivers, completed an inventory on coping and another on burnout. Coping strategies alone do not preclude burnout but may help prevent worker turnover. High job and salary satisfaction, together with active coping strategies play an important role in promoting personal accomplishment. Low job and salary satisfaction and the use of passive or emotional strategies predict elevated emotional exhaustion. The results suggest some possible points of intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors influencing job satisfaction on specialty nursing units

In the midst of downsizing, restructuring, layoffs, hospital closures, mergers, and the beginning cycle of shortages in specialty units, nursing administrators must extend their understanding of the factors influencing job satisfaction and the implications these findings may have for nursing practice, in order to enhance the quality of worklife for nurses in a hospital setting and create competitive work environments. The Causal Model of Job Satisfaction for Nurses (Blegen & Mueller, 1987), including Leatt and Schneck's (1981) technology variable, was the conceptual framework used to look at the effect of the 14 variables (opportunity, routinization, autonomy, job communication, social integration, distributive justice, promotional opportunity, motivation, pay, workload, general training, kinship responsibility, unit size, technology) on job satisfaction. This study demonstrated a statistically significant positive correlation between autonomy, motivation and job satisfaction and a statistically significant negative correlation between routinization and job satisfaction.     

Core Self-Evaluations and Job Burnout: The Test of Alternative Models.

Research on job burnout has traditionally focused on contextual antecedent conditions, although a theoretically appropriate conception implicates person-environment relationships. The authors tested several models featuring various combinations of personal and contextual influences on burnout and job satisfaction. Measures of core self-evaluations, organizational constraints, burnout, and job satisfaction were collected from 859 health care employees. Results from structural equations modeling analyses revealed an influence of core self-evaluations and perceived organizational constraints on job burnout and satisfaction, suggesting personal and contextual contributions. These results favor a broadening of current thinking about the impact of situational constraints on the expression of job burnout, as well as for the role of disposition for affective responding to effectively address occupational health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vitrectomy and fluid/silicone oil exchange for giant retinal tears: 10-year follow-up

Decentralization is increasingly used in departments of nursing to achieve such outcomes as cost containment, job satisfaction, and improved patient care. Because decentralization is considered invaluable in today's rapidly changing health care environment, nurse educators must be knowledgeable regarding its principles and barriers. Their educational role and their support of staff during the transition period are critical to successful implementation.     

Taking down the walls: a nurse manager's experience in acute care and home care

Changes in the health care system are stimulating trends in where and how nursing services are delivered. Nurse managers are responsible for the overall management of the nursing work unit and must be prepared to practice in settings other than acute care. Home care is a rapidly growing practice that emerges as patients are discharged from the hospital sooner with ongoing medical and nursing needs. The job responsibilities of a nurse manager remain similar across practice settings, including the transition from acute care to home care. A detailed checklist highlights specific similarities and differences in the nurse manager's role in acute care and home care settings. As the walls of the practice setting are taken down, nurse managers must build on current knowledge and creatively develop new skills to remain successful in ongoing job responsibilities.     

A meta-analytic examination of work and general locus of control.

The current meta-analysis examined the hypothesized consequences of work and general locus of control. As expected, work locus of control generally yielded stronger relationships with work-related criteria (e.g., job satisfaction, affective commitment, and burnout) than general locus of control. We also found some evidence that general locus of control yielded relatively stronger relationships with general criteria (e.g., life satisfaction, affective commitment, and burnout). Regression analysis found several unique effects for both work and general locus of control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of a CareMap and case management on patient satisfaction and staff satisfaction, collaboration, and autonomy

The purpose of this research was to evaluate the effect of a CareMap and nursing case management on patient satisfaction and staff job satisfaction, collaboration, and autonomy. The patients who had a CareMap and a nurse case manager were more satisfied with their care. The multidisciplinary staff who worked on the experimental unit had increased job satisfaction and nurses who applied and were selected for case management positions had higher levels of collaboration and increased autonomy. Multidisciplinary team members who developed the CareMap also had higher levels of collaboration than other multidisciplinary staff on the experimental unit and their job satisfaction with quality of care increased under this new care delivery system.     

Symptoms of professional burnout: A review of the empirical evidence.

Reviews empirical literature, 1974–1984, concerning symptoms of burnout among human service professionals. Symptoms of burnout are grouped into 5 categories: physical, emotional, behavioral, interpersonal, and attitudinal. It is concluded that burnout is associated with poor physical health; depression; job turnover and unproductive work behaviors; problematic interpersonal relations; and negative attitudes, especially with regard to job satisfaction. Problems with research include lack of operational definition, defects in instruments, and impressionistic findings. Future needs include further exploration of content, attention to interactive effects, and alternative methodologies. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sources of social support and burnout, job satisfaction, and productivity.

Social support has been identified as an important correlate of a variety of work outcomes. Support from different sources, including family, coworkers, and supervisors, was examined in 211 traffic enforcement agents (92 men, 119 women). Outcomes included subjective variables (burnout and job satisfaction) and an objective measure of productivity (number of summonses). Support was negatively associated with burnout and positively associated with satisfaction and productivity. A cluster of support variables accounted for 7% of the variance in burnout and productivity and 12% of the variance in job satisfaction. Family support was more closely associated with burnout than with satisfaction or productivity, whereas immediate supervisor support was related to satisfaction and productivity but not burnout. Results suggest that support may be associated with work-related outcomes through multiple pathways. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Afferent mechanism of cortical myoclonus studied by proprioception-related SEPs

This questionnaire study examined perceived sources of stress and satisfaction at work among 121 mental health staff members. Five factors were derived from principal component analysis of sources of work stress items (stress from: role, poor support, clients, future, and overload), and accounted for 70% of the total variance. Four factors were derived from the items related to sources of job satisfaction (satisfaction from: career, working with people, management, and money), accounting for 68% of the variance. The associations of these factors with sociodemographic and job characteristics were examined, and they were entered as explanatory variables into regression models predicting mental health, burnout, and job satisfaction. Stress from "overload" was associated with being based outside an in-patient ward, and with emotional exhaustion and worse mental health. Stress related to the "future" was associated with not being white. Stress from "clients" was associated with the "depersonalization" component of burnout. Higher job satisfaction was associated with "management" and "working with people" as sources of satisfaction, whereas emotional exhaustion and poorer mental health were associated with less "career" satisfaction.     

Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.     

Balanced designs in longitudinal population pharmacokinetic studies

Despite the proliferation of research on primary nursing, most studies have investigated the effects of primary nursing on quality of care, job satisfaction and collegial relationships. Few researchers have attempted to isolate the key dimensions of primary nursing in an observable and measurable form. The purpose of this exploratory study was to devise an audit tool for primary nursing that builds on Mead's research and incorporates views of patients/clients, relatives, nurses and other members of the multidisciplinary team. Preliminary findings suggest that the audit is a useful indicator of the extent to which the crucial elements of primary nursing are present or absent in any clinical setting. Furthermore it suggests that while many wards claim to practise primary nursing there is a considerable variation in the extent to which this is actually carried out.     

The relation between leadership style and empowerment on job satisfaction of nurses

OBJECTIVE: The authors explore the relation between leadership style and empowerment and its effect on job satisfaction among the nursing staff of a regional medical center. BACKGROUND: Several empirical studies on transformational leadership-found that transformational leadership behaviors were positively related to work team success and leadership effectiveness. Transformational leadership processes have also been suggested to enhance followers' work-oriented values and shape the self-efficacies of followers. Employee empowerment may be influenced by the perception that the organization cares about its employees' well-being and that their work is valued. Empowering nurses may increase job satisfaction and improve patient care. Leadership style and empowerment influence job satisfaction among workers. METHODS: All nursing department staff were invited to complete a self-report questionnaire with no identifying information. Leadership style was measured using Bass's Multifactor Leadership Questionnaire, empowerment was measured with items from Spreitzer's Psychological Empowerment instrument, and job satisfaction was measured by Warr, Cook, and Wall's job satisfaction questionnaire. RESULTS: Both transformational and transactional leadership were positively related to job satisfaction, as was empowerment. Differences in the contributions of empowerment and leadership style in predicting job satisfaction for licensed and unlicensed workers was evident. CONCLUSION: Designing interventions that allow for the relative influence of leadership style as well as empowerment on varying classifications of nursing personnel may be a more effective strategy and have a greater effect on staff attitudes and behaviors.     

Collaborative care: a professional model that influences job satisfaction

At Overland Park Regional Medical Center/Columbia/HCA, Inc., the challenge was to implement a new patient care delivery model and measure the effect of this model on job satisfaction. In reviewing the literature, experts on case management/managed care noted a relationship between this form of practice model and high levels of job satisfaction. However, this relationship was not well illustrated through research studies. Analysis of this implementation plan demonstrated that managed care had a positive impact on job satisfaction.