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Background: Longer life expectancy and changes in family patterns in Western societies have increased the need for professional caregivers to the elderly. A detailed understanding of job resources, especially of job control, may help preserve eldercare workers' work-related well-being. Objectives: The aim of the present study was to determine optimal levels of job control for eldercare workers' work-related well-being. Design: Cross-sectional (Study 1) and longitudinal (Study 2) data were used to assess the linear and non-linear relations between job control and eldercare workers' work-related well-being. As indicators of well-being, irritation was examined cross-sectionally, whereas burnout and engagement were used in the longitudinal study. In both studies, demographic variables and time pressure were included as controls. In Study 2, results were additionally controlled for baseline levels of the outcome variables. Participants: Study participants were recruited from the nursing staff of 10 publicly ?nanced nursing homes for the elderly (Study 1) and from 18 privately and 20 publicly ?nanced nursing homes for the elderly (Study 2). In both studies, eldercare workers (i.e., registered nurses, orderlies, and nursing assistants) were invited to answer paper-pencil questionnaires. In Study 1, 606 persons followed this invitation (response rate: 65%). In Study 2, 591 persons provided data on both measurement points (response rate: 35% of Time 1 participants). The samples of both studies were predominantly female and between 20 and 65 years of age. Methods: Hierarchical multiple regressions with linear and quadratic terms were conducted. Results: Curvilinear effects of job control were found in both studies. In Study 1, low as well as high levels of job control were associated with higher levels of irritation compared to medium levels of job control. The longitudinal data from Study 2 supported these results. Eldercare workers with higher and lower levels of job control reported a higher tendency to depersonalize care recipients and a lower tendency to feel dedicated to, absorbed by and vigorous at work than those with medium levels of job control. Conclusions: Higher levels of job control are not necessarily advantageous for work-related well-being of eldercare workers. [ABSTRACT FROM AUTHOR]

Abstract: Aims/background: The retention of student nurses continues to concern the education sector internationally. Evidence shows that individual factors are correlated with a high risk of attrition, including age, disability, entry qualifications, financial issues, and placement experience. This paper is a report of a study that aimed to examine factors connected to progression and attrition by mapping student characteristics against Year 1 progression data. Method: The study used a retrospective cohort design. Students within five cohorts in a single University in the north of England were invited to be included (n =807). Quantitative data were collected from the University''s information system (October 2009–January 2010). Of the total potential participants, 695 were included (13.8% excluded). Multinomial logistic regression was used to ascertain factors that predicted progression. Results: As age on entry increased, the likelihood of non-progression from year one became less: i.e. older students appeared to be more likely to progress than their younger counterparts (p <0.001, likelihood ratio chi-square test). Students who lived away from the local area outside term-time were significantly less likely to progress than those whose term-time and holiday domicile were the same (p =0.007, likelihood ratio chi-square test). Students with dependents or previous care experience seemed more likely to progress than those without, although this was not statistically significant in a multivariable regression model. Conclusion: With the changing demographic profile of students, the new ‘all-graduate’ programmes need to consider student characteristics that are correlated with likelihood of progression and not just focus on those that precipitate exit. [Copyright &y& Elsevier]

Abstract: Background: Achieving asthma control is central to optimising patient quality of life and clinical outcome. Contemporary models of chronic disease management across a variety of countries point to the importance of micro, meso and macro level influences on patient care and outcome. However, asthma outcomes research has almost invariably concentrated on identifying and addressing patient predictors. Little is known about higher level organisational influences. Objective: This paper explores the contribution of organisational factors on poor asthma control, allowing for patient factors, at three organisational levels: the individual patient, local service deliverers, and strategic regional providers. Design, setting and participants: Prospective cross-sectional observational cohort study of 64,929 people with asthma from 1205 primary care practices spread throughout the United Kingdom (UK). Patient clinical data were recorded during a routine asthma review. Method: Data were analysed using simple descriptive, multiple regression and complex multi-level modelling techniques, accounting for practice clustering of patients. Results: Poor asthma control was associated with areas of higher deprivation [regression coefficient 0.026 (95% confidence intervals 0.006; 0.046)] and urban practice [−0.155 (−0.275; −0.035)] but not all local and regional variation was explained by the data. In contrast, patient level predictors of poor control were: short acting bronchodilator overuse [2.129 (2.091; 2.164)], days-off due to asthma [1.203 (1.148; 1.258)], PEFR<80 [0.76 (0.666; 0.854)], non-use of a self-management plan (SMP) [0.554 (0.515; 0.593)], poor inhaler technique [0.53 (0.475; 0.585)], poor medication compliance [0.385 (−0.007; 0.777)], and gender [0.314 (0.281; 0.347)]. Pattern of medication use, smoking history, age, body mass index (BMI), and health service resource use were also significant factors for predicting control. Conclusions: Targeting of health service resource requires knowledge of the factors associated with poor control of asthma symptoms. In the UK the contribution of local and regional structures appears minimal in explaining variation in asthma outcomes. However, unexplained variation in the data suggests other unrecorded factors may play a part. While patient personal characteristics (including self-management plan use, inhaler technique, medication compliance) appear to be the predominant influence the complex nature of the disease means that some, perhaps more subtle, influences are affecting the variability at all levels and this variance needs to be explored. Further research in other international contexts is required to identify the likely applicability of these findings to other health care systems. [Copyright &y& Elsevier]

Abstract: Background: As cardiovascular diseases have become the leading cause of death in many countries including China, nurses are increasingly required to be abreast of technological advances and the skills necessary to manage this increasing health care problem. Chinese nurses are under pressure to provide skilled electrocardiography monitoring, and be sufficiently skilled to detect myocardial ischemia and infarction, in this large patient population. This presents a challenge for the nursing profession in China, particularly for nurses working in coronary care in a country where advancement has been so rapid, yet little research has been conducted or reported in the literature. Objectives: The two main objectives were: to explore the demographic and educational factors that affect the use of ST-segment monitoring and correct electrode placement by CCU/ICU nurses in China; and to explore the factors both individual and institutional that affect monitoring and lead placement. Methods: A self-administered questionnaire was distributed to nurses in 126 randomly selected tertiary hospitals, which were stratified into three homogeneous regions across China. The instrument examined demographics, information about hospitals, electrocardiogram devices, current practice patterns and perceptions toward monitoring and lead placement. Data from 734 nurses and 59 nurse managers from 59 hospitals were analyzed using t-tests, ANOVA, Chi-square test and logistic regression. Results: Electrocardiogram monitoring was used to detect myocardial ischemia by 43.7% of respondents, and 35.1% selected leads according to electrocardiogram or angiography findings. Most (70%) agreed that monitoring for acute coronary syndrome was important, while 39.2% did so, and 15.7% were able to identify correct placement. Logistic regression revealed a significant relationship between the uses of ST-segment monitoring and number of hospital beds, continuing education and a belief in its use and ease of use. Correct electrode placement was significantly correlated with respondents from university hospitals, hospitals with more acute coronary syndrome admissions and more independent thinking nurses. Conclusions: Despite best practice evidence, less than half of the sample used electrocardiogram monitoring to detect myocardial ischemia and the majority could not identify correct electrode placement, while ST-segment monitoring was not used routinely. This paper highlights the need for improvements in education both in universities and hospitals and discussion addresses conventions in units, which inhibit development of nurses’ skills. [Copyright &y& Elsevier]