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rochefort c.m. & clarke s.p. (2010) Nurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal of Advanced Nursing 66(10), 2213–2224. Aim. This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses’ perceptions of care rationing, job outcomes, and quality of care. Background. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Methods. Over a 6-month period in 2007–2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). Results. A total of 339 nurses (61·3%) completed questionnaires. Overall, 18·6% were dissatisfied with their job, 35·7% showed high emotional exhaustion, and 19·2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Conclusion. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper describes a study that aimed to identify research priorities for the care of infants, children and adolescents at the sole tertiary referral hospital for children in Western Australia. The secondary aim was to stimulate nurses to explore clinical problems that would require further inquiry. Background. Planning for research is an essential stage of research development; involving clinicians in this exercise is likely to foster research partnerships that are pertinent to clinical practice. Nursing research priorities for the paediatric population have not previously been reported in Australia. Design. Delphi study. Method. Over 12 months in 2005–2006, a three-round questionnaire, using the Delphi technique, was sent to a randomly selected sample of registered nurses. This method was used to identify and prioritise nursing research topics relevant to the patient and the family. Content analysis was used to analyse Round I data and descriptive statistics for Round II and III data. Results. In Round I, 280 statements were identified and reduced to 37 research priorities. Analysis of data in subsequent rounds identified the top two priority research areas as (1) identification of strategies to reduce medication incidents (Mean = 6·47; SD 0·88) and (2) improvement in pain assessment and management (Mean = 6; SD 1·38). Additional comments indicated few nurses access the scientific literature or use research findings because of a lack of time or electronic access. Conclusions. Thirty-seven research priorities were identified. The identification of research priorities by nurses provided research direction for the health service and potentially other similar health institutions for children and adolescents in Australia and internationally. Relevance to clinical practice. The nurse participants showed concern about the safety of care and the well-being of children and their families. This study also enabled the identification of potential collaborative research and development of pain management improvement initiatives. [ABSTRACT FROM AUTHOR]

Aims To integrate existing theoretical perspectives on change management, subjective fit and occupational stress to better understand the effects of change on employee adjustment. Background Although subjective fit with organizational goals and objectives has been shown to have positive effects on employee adjustment, its role in the organizational change-occupational stress context is not understood. This represents a caveat in research when considering the notion that those who feel that they fit with the organization's goals may be better equipped to reconcile and deal with change. Design A cross-sectional survey of nurses from public and non-profit sector hospitals was conducted. Method Data were collected from 252 public and non-profit sector nurses via online surveys. Data were collected from June-October in 2010. Structural equation modelling was used to test the direct and indirect effects among the focal variables. Results The results showed that public and non-profit nurses experience flexibility-limiting and flexibility-promoting change initiatives and that these are differentially related to the perception of administrative stressors and adjustment with these relationships directly and indirectly influenced by perceptions of subjective fit. Flexibility-limiting change initiatives led to lower levels of subjective fit, higher levels of administrative stressors and less favourable adjustment. On the other hand, flexibility-promoting change practices led to higher levels of subjective fit, lower levels of administrative stressors and ultimately better adjustment. Conclusion The results further the theoretical understanding of the role of subjective fit in organizational change and occupational stress theories. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess Malaysian nurses' perceived job satisfaction and to determine whether any association exists between job satisfaction and intention to leave current employment. Background There is currently a shortage of qualified nurses, and healthcare organisations often face challenges in retaining trained nurses. Job satisfaction has been identified as a factor that influences nurse turnover. However, this has not been widely explored in Malaysia. Design Cross-sectional survey. Methods Registered nurses in a teaching hospital in Malaysia completed a self-administered questionnaire. Of the 150 questionnaires distributed, 141 were returned (response rate = 94%). Results Overall, nurses had a moderate level of job satisfaction, with higher satisfaction for motivational factors. Significant effects were observed between job satisfaction and demographic variables. About 40% of the nurses intended to leave their current employment. Furthermore, age, work experience and nursing education had significant associations with intention to leave. Logistic regression analysis revealed that job satisfaction was a significant and independent predictor of nurses' intention to leave after controlling for demographic variables. Conclusion The results suggest that there is a significant association between job satisfaction and nurses' intention to leave their current employment. It adds to the existing literature on the relationship between nurses' job satisfaction and intention to leave. Relevance to clinical practice Methods for enhancing nurses' job satisfaction are vital to promote the long-term retention of nurses within organisations. Attention must be paid to the needs of younger nurses, as they represent the majority of the nursing workforce and often have lower satisfaction and greater intention to leave than older nurses do. Strategies to nurture younger nurses, such as providing opportunities for further education, greater management decision-making capabilities and flexible working environment, are essential. [ABSTRACT FROM AUTHOR]

Aim. To assess the discriminative and construct validity of the Multidrug-Resistant Bacteria Attitude Questionnaire and to study registered nurses' knowledge of, behaviour toward and emotional responses to patients with multidrug-resistant bacteria in relation to how they understand their own, managers' and politicians' responsibility for adherence to preventive measures for infection control. Background. Multidrug-resistant organisms are a global problem and an essential topic in healthcare regarding patient safety improvement. Design. Descriptive and correlational cross-sectional survey. Method. Data were collected in a non-random sample consisting of 397 registered nurses; district, haematology or infection registered nurses. One-way analysis of variance and independent t-tests were used for comparisons and a principal component analysis was performed. Results. Discriminative and construct validity were supported, as the infection registered nurses generally had higher scores on knowledge, behaviour and emotional response, compared with district registered nurses and haematology registered nurses and the three-factor solution was confirmed. Registered nurses with higher scores on knowledge and emotional response attributed greater responsibility to themselves and to politicians. The Multidrug-Resistant Bacteria Attitude Questionnaire was translated using a forward-back translation process. Conclusion. The questionnaire has adequate psychometric properties. Insufficient knowledge of, behaviour toward and emotional response to patients with multidrug-resistant bacteria were described, but the registered nurses did estimate their own responsibility for adherence to preventive measures for infection control as being great or very great. Relevance to clinical practice. There is a considerable need to improve knowledge, behaviour and emotional response regarding infection prevention measures among healthcare workers. The hospital management are responsible for such improvements and the Multidrug-Resistant Bacteria Attitude Questionnaire is useful in identifying such needs, as it has adequate psychometric properties and is able to discriminate between groups. Evaluation among healthcare workers may indicate where to situate additional training, as this is of clinical significance for safe care. [ABSTRACT FROM AUTHOR]

Background: The increasing prevalence of diabetes and obesity represents a significant disease burden in Australia. Practice nurses (PNs) play an important role in diabetes education and management. Aim: To explore PNs' roles, knowledge and beliefs about diabetes education and management in rural and remote general practice in Australia. Method: Exploratory study undertaken in three phases: 1) Pilot study to test the performance of the questionnaire; 2) One-shot cross-sectional survey using self-complete questionnaires; 3) Individual interviews. Results: Ten PNs completed the pilot test; the draft questionnaire was deemed appropriate to the study purpose. Then, 65 questionnaires were distributed to PNs and 21 responded. Fourteen respondents had worked in the role <5 years, and most PNs attended diabetes education programmes in their workplace. A minority (40%) used diabetes management guidelines regularly. Most knew obesity to be the most common risk factor for diabetes but only 50% knew that glycosylated haemoglobin indicates blood glucose levels over the preceding three months. Self-reported competency to assess patients' self-care practices and medication management practices varied. Conclusion: PNs' diabetes management was self-reported; their knowledge varied and their perceived benefits of diabetes education differed from those of patients. Copyright © 2010 FEND [ABSTRACT FROM AUTHOR]