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Geese F, Bryant-Lukosius D, Zwakhalen S, Hahn S. Advanced Practice Nurses and Their Roles in Swiss Cancer Care: A Cross-Sectional Study. Semin Oncol Nurs 2024:151626. [PMID: 38641521 DOI: 10.1016/j.soncn.2024.151626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/25/2024] [Accepted: 03/08/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES To examine the advanced practice nurse workforce in Swiss cancer care and how their roles are being implemented (eg, role structures, processes) to achieve optimal outcomes for patients and their families, care organizations, and the broader health care system. METHODS A cross-sectional study was conducted. The sample included master-prepared advanced practice nurses in cancer care, who completed an online questionnaire from December 2021 to January 2022. Thirty-nine items assessed structures (eg, role characteristics, utilization), processes (eg, role activities, interventions), and perceived outcomes (eg, for patients, the health care system) of advanced practice nurses in Swiss cancer care. Data from closed questions were analyzed using descriptive statistics. Data from open-ended questions were organized and summarized into categories related to domains of advanced practice nursing and its reported frequency by the advanced practice nurses. RESULTS The participating advanced practice nurses (n = 53), worked in half of the 26 Swiss cantons. Interventions were identified within nine categories, of which most were targeted to patients and their families (n = 7), followed by health care professionals (n = 2). Perceived positive outcomes were patient symptom management, length of hospital stay, and health care costs. Participants felt less confident in cancer care (eg, autonomous practice) and reported 15 professional development needs (eg, medical interventions, teaching). CONCLUSIONS This study provides a comprehensive examination of 53 advanced practice nurses, detailing the characteristics of their roles and utilization across various jurisdictions and health care settings. The results highlight the diverse dimensions of advanced practice nursing and its potential to enhance cancer services and outcomes in Switzerland. Opportunities for role development support and expansion are identified. IMPLICATIONS FOR NURSING PRACTICE More systematic health human resource planning is needed to expand the deployment of advanced practice nurses across jurisdictions, practice settings, and more diverse patient populations. Role development needs show the desire for specialized educational preparation in cancer care.
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Affiliation(s)
- Franziska Geese
- Academic Practice Partnership, School of Health Professions, Bern University of Applied Sciences, Switzerland; University Hospital Bern, Inselspital, Insel Gruppe, Freiburgstrasse, Switzerland.
| | - Denise Bryant-Lukosius
- School of Nursing and Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Zwakhalen
- Department of Health Services Research, Maastricht University, Netherlands
| | - Sabine Hahn
- Division of Nursing, School of Health Professions, Bern University of Applied Sciences, Switzerland
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2
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Nordlinder C, Bergström G, Tham P, Öberg P. Individual, family, job, and organizational factors associated with retirement intentions among older long-term care workers: A systematic review. Geriatr Nurs 2024; 56:83-93. [PMID: 38325072 DOI: 10.1016/j.gerinurse.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
This systematic review synthesized prior quantitative research on individual, family, job, and organizational factors associated with retirement intentions (RI) among older long-term care (LTC) workers. Seven databases were searched for peer-reviewed studies. RI were defined as early (<65 years) or late (>65 years). To assess the methodological quality, we used JBI's checklists. The PRISMA statement guided this review. After duplicates were removed, 4 489 records were identified. A final sample of six articles was selected as eligible for inclusion. Current findings show weak social support, high physical job demands, and type of LTC occupation as important determinants for early RI. Strong social support and good job resources are important determinants fore late RI. In contrast to earlier research on other groups of older workers, this review shows no statistically associations between health nor emotional job demands and early RI for LTC workers. The results are discussed using the JD-R theory.
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Affiliation(s)
- Carolina Nordlinder
- Department of Social Work and Criminology, Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, Gävle 801 76, Sweden.
| | - Gunnar Bergström
- Department of Social Work and Criminology, Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, Gävle 801 76, Sweden; Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pia Tham
- Department of Social Work and Criminology, Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, Gävle 801 76, Sweden; Department of Social Work, Uppsala University, Uppsala, Sweden
| | - Peter Öberg
- Department of Social Work and Criminology, Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, Gävle 801 76, Sweden
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3
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Bostock F, Mortimore G. Considering the impact of shift working on health. Br J Nurs 2024; 33:120-124. [PMID: 38335102 DOI: 10.12968/bjon.2024.33.3.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Shift work is necessary for the provision of health services, especially in hospitals as it is the only way to provide continuous care to patients. Working at night is inconsistent with the body's biological clock and night shift working hugely disrupts the circadian and sleep wake cycles. In 2020, the World Health Organization classified night shift working as being a 'probable' class 2A carcinogen and a number of independent cohort studies of both night workers and shift workers have observed increased incidence of certain cancers. Altered sleep timing, food timing and light exposure typical for shift workers leads to an acute circadian disruption and misalignment of regulatory hormones. This straying from synchronisation has been shown to result in individuals being more vulnerable to a number of chronic health conditions. Night shift work disrupts the normal sleep-wake cycle, often leading to shortened sleep duration and excessive fatigue and the results of this are far reaching. This article will explore the full impact of shift working, questioning if current practices employed within the NHS should continue.
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Affiliation(s)
- Faye Bostock
- Trainee Advanced Clinical Practitioner, University Hospitals of Derby and Burton Foundation Trust
| | - Gerri Mortimore
- Associate Professor in Advanced Practice, Department of HPSC, University of Derby
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Cohen J, van der Meulen Rodgers Y. An intersectional analysis of long COVID prevalence. Int J Equity Health 2023; 22:261. [PMID: 38093291 PMCID: PMC10717295 DOI: 10.1186/s12939-023-02072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Long COVID symptoms - which include brain fog, depression, and fatigue - are mild at best and debilitating at worst. Some U.S. health surveys have found that women, lower income individuals, and those with less education are overrepresented among adults with long COVID, but these studies do not address intersectionality. To fill this gap, we conduct an intersectional analysis of the prevalence and outcomes of long COVID in the U.S. We posit that disparities in long COVID have less to do with the virus itself and more to do with social determinants of health, especially those associated with occupational segregation and the gendered division of household work. METHODS We use 10 rounds of Household Pulse Survey (HPS) data collected between June 2022 and March 2023 to perform an intersectional analysis using a battery of descriptive statistics that evaluate (1) the prevalence of long COVID and (2) the interference of long COVID symptoms with day-to-day activities. We also use the HPS data to estimate a set of multivariate logistic regressions that relate the odds of having long COVID and activity limitations due to long COVID to a set of individual characteristics as well as intersections by sex, race/ethnicity, education, and sexual orientation and gender identity. RESULTS Findings indicate that women, some people of color, sexual and gender minorities, and people without college degrees are more likely to have long COVID and to have activity limitations from long COVID. Women have considerably higher odds of developing long COVID compared to men, a disparity exacerbated by having less education. Intersectional analysis by gender, race, ethnicity, and education reveals a striking step-like pattern: college-educated men have the lowest prevalence of long COVID while women without college educations have the highest prevalence. Daily activity limitations are more evenly distributed across demographics, but a different step-like pattern is present: fewer women with degrees have activity limitations while limitations are more widespread among men without degrees. Regression results confirm the negative association of long COVID with being a woman, less educated, Hispanic, and a sexual and gender minority, while results for the intersectional effects are more nuanced. CONCLUSIONS Results point to systematic disparities in health, highlighting the urgent need for policies that increase access to quality healthcare, strengthen the social safety net, and reduce economic precarity.
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Affiliation(s)
- Jennifer Cohen
- Department of Global and Intercultural Studies, Miami University, Oxford, OH, USA.
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Voth Schrag RJ, Fantus S, Leat S, Childress S, Wood L. Experiencing Moral Distress Within the Intimate Partner Violence & Sexual Assault Workforce. J Fam Violence 2023:1-13. [PMID: 37358973 PMCID: PMC10132954 DOI: 10.1007/s10896-023-00567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/28/2023]
Abstract
Purpose Moral distress (MD) refers to the psychological disequilibrium that emerges when institutional policies and/or practices conflict with an individual's professional values and ethics. MD has been interrogated frequently in health care and ancillary medical settings, and has been identified as a critical barrier to enhanced organizational climate and patient care. However, little work has investigated experiences of MD among members of the intimate partner violence (IPV) and sexual violence (SV) workforce. Methods This study investigates MD in a sample of IPV and SV service providers via secondary analysis of 33 qualitative interviews conducted with service providers in the summer and fall of 2020 as the COVID-19 pandemic response was unfolding. Results Qualitative content analysis revealed multiple overlapping vectors of MD experienced by IPV and SV service providers related to institutional resource constraints, providers working beyond their capacity and/or competency, shifting responsibilities within service agencies creating burdens among staff; and breakdowns in communication. Impacts of these experiences at individual, organizational, and client levels were identified by participants. Conculsions The study uncovers the need for further investigation of MD as a framework within the IPV/SV field, as well as potential lessons from similar service settings which could support IPV and SV agencies in addressing staff experiences of MD.
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Affiliation(s)
- Rachel J. Voth Schrag
- The University of Texas at Arlington School of Social Work, 211 S. Cooper, Arlington, TX 76019 USA
| | - Sophia Fantus
- The University of Texas at Arlington School of Social Work, 211 S. Cooper, Arlington, TX 76019 USA
| | | | - Saltanat Childress
- The University of Texas at Arlington School of Social Work, 211 S. Cooper, Arlington, TX 76019 USA
| | - Leila Wood
- The University of Texas Medical Branch at Galveston, Galveston, USA
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Xiao L, Gregoric C, Gordon S, Ullah S, Goodwin-Smith I, Muir-Cochrane E, Blunt S. Comparisons on factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes: a qualitative study. BMC Geriatr 2023; 23:81. [PMID: 36750926 PMCID: PMC9903278 DOI: 10.1186/s12877-023-03800-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Studies revealed that supporting residents fulfilling self-determination is positively associated with their health, wellbeing and quality of life. Cross-cultural care poses significant challenges for nursing home residents to fulfil their self-determination in control of own care and maintaining meaningful connections with others. The aim of the study was to compare factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes. METHODS A qualitative descriptive approach was applied to the study. Culturally competent care and person-centred care were employed as guiding frameworks. Individual interviews or a focus group with residents and family members were conducted to collect data. RESULTS In total, 29 participants participated in the study. Three main themes were identified: communicating needs and preferences; mastering own care; and maintaining meaningful relationships. Each theme includes sub-themes that detail similarities and differences of factors affecting residents fulfilling self-determination in the two type nursing homes. Findings indicate that residents from both types of nursing homes experienced challenges to communicate their care needs and preferences in daily care activities. Moreover, residents or their representatives from both types of nursing homes demonstrated motivation and competence to master residents' care based on their individual preferences, but also perceived that their motivation was not always supported by staff or the nursing home environment. Residents' competence in mastering their care activities in ethno-specific nursing homes was based on the condition that they were given opportunities to use a language of choice in communication and staff and the nursing home demonstrated culturally competent care for them. In addition, ethno-specific nursing homes showed more recourse to support residents to maintain meaningful relationships with peers and others. CONCLUSIONS Culturally competent care created by staff, nursing homes and the aged care system is a basic condition for residents from ethnic minority groups to fulfil self-determination. In addition, person-centred care approach enables residents to optimise self-determination.
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Affiliation(s)
- Lily Xiao
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.
| | - Carolyn Gregoric
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia 5042 Australia
| | - Sue Gordon
- grid.1014.40000 0004 0367 2697Flinders University, Adelaide, Australia
| | - Shahid Ullah
- grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ian Goodwin-Smith
- grid.1014.40000 0004 0367 2697College of Business, Government & Law, Flinders University, Adelaide, Australia
| | - Eimear Muir-Cochrane
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia 5042 Australia
| | - Sara Blunt
- Kalyra Communities, Adelaide, South Australia Australia
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Abstract
BACKGROUND AND OBJECTIVES High turnover and recruitment challenges of nursing home employees and managers are an ongoing concern. This study's objective was to examine intent to quit among all staff and assess the roles of job characteristics and job satisfaction. Employees and managers within one nursing home chain working in direct patient care or nursing were compared. RESEARCH DESIGN AND METHODS Data came from the Work, Family, Health Network 18-month follow-up survey in 2012 (total = 1,000, managers = 101, employees = 899). A cumulative logit model controlling for demographics was estimated for intent to quit. Herzberg's Two-Factor Theory of Work Motivation guided the study. RESULTS Employees scored significantly lower on family-supportive supervisor behaviors (FSSBs), schedule control, and decision authority than managers. Employees and managers did not differ on job satisfaction, intent to quit, or job demands. Satisfied workers had an 83% decrease in the odds of reporting an intent to quit compared to workers who were neutral or disagreed (odds ratio [OR] = 0.17, p < .0001). Decision authority (OR = 3.49) and schedule control (OR = 5.18) were independently related to greater odds of reporting an intent to quit. In contrast, FSSBs (OR = 0.69), safety compliance (OR = 0.71), and the combination of high decision authority with high schedule control (OR = 0.72) were related to lower odds of reporting an intent to quit. DISCUSSION AND IMPLICATIONS Among nursing home staff, lower intent to quit may be achieved through improving job satisfaction, the quality of supervision, safety culture, and job enrichment through more schedule control and decision-making power.
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Affiliation(s)
- Katherine A Kennedy
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - David C Mohr
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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8
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Kennedy KA, Bowblis JR. Does Higher Worker Retention Buffer Against Consumer Complaints? Evidence From Ohio Nursing Homes. Gerontologist 2023; 63:96-107. [PMID: 35931418 DOI: 10.1093/geront/gnac119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined the relationship between nursing home (NH) quality using consumer complaints and certified nursing assistant (CNA) annual retention rates among Ohio freestanding NHs (n = 691). RESEARCH DESIGN AND METHODS Core variables came from the 2017 Ohio Biennial Survey of Long-term Care Facilities and Centers for Medicare and Medicaid Services Automated Survey Processing Environment Complaints/Incidents Tracking System. To compare NHs, 4 quartiles of CNA retention rates were created: low (0%-48%), medium (49%-60%), high (61%-72%), and very high retention (73%-100%). Negative binomial regressions were estimated on total, substantiated, and unsubstantiated allegations and complaints. All regressions controlled for facility and county-level factors and clustered facilities by county. RESULTS NHs in the top 50% (high and very high) of retention received 1.92 fewer allegations than those in the bottom 50%, representing a 19% difference; this trend was significant and negative across all outcomes. Using quartiles revealed a nonlinear pattern: high-retention NHs received the fewest number of allegations and complaints. The differences between high and low retention on allegations, substantiated, and unsubstantied allegations were 33% (3.73 fewer), 34% (0.51 fewer), and 32% (3.12 fewer), respectively. Unexpectedly, very high-retention NHs received more unsubstantiated allegations than high-retention NHs. DISCUSSION AND IMPLICATIONS While higher-retention should result in fewer complaints, our results indicate that some turnover may be desirable because the very high-retention NHs performed slightly worse than those with high retention. Among the remaining facilities, fewer complaints may be achieved by improving CNA retention through higher wages, career advancement, and better training.
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Affiliation(s)
- Katherine A Kennedy
- Center for Innovation in Long-Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - John R Bowblis
- Department of Economics, Farmer School of Business, Miami University, Oxford, Ohio, USA.,Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
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Abrams LR, Harknett K, Schneider D. Older Workers with Unpredictable Schedules: Implications for Well-being and Job Retention. Gerontologist 2022; 62:1443-1453. [PMID: 35583307 DOI: 10.1093/geront/gnac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A substantial portion of the service sector workforce is middle aged or older, but little is known about the scheduling conditions of these older workers. This study describes the quality of work schedules in the service sector by age and tests associations of unpredictable schedules with well-being and job retention among workers ages 50-80. RESEARCH DESIGN AND METHODS The Shift Project collected survey data on detailed working conditions and health from 121,408 service sector workers, recruited in 2017-2020 using social media advertisements. Survey weights aligned sample demographics with the American Community Survey, and multiple imputation addressed missingness. Ordinary least squares regression models were used to examine associations between age and schedule stability, and ordinary least squares, ordinal logit, and logit regression models tested associations between schedule stability and well-being and job retention outcomes for older workers. RESULTS Scheduling conditions were more stable and predictable for older compared to younger workers; however, more than 80% of workers ages 50-80 experienced one or more types of routine schedule instability. Among workers ages 50-80, unpredictable schedules were associated with psychological distress, poor quality sleep, work-family conflict, economic insecurity, job dissatisfaction, and intentions to look for a new job. Canceled and back-to-back closing and opening ("clopening") shifts were most strongly associated with negative outcomes. DISCUSSION AND IMPLICATIONS Policies aimed at improving scheduling conditions hold promise to benefit older service workers' well-being. As the population ages, improving work schedules in the years approaching retirement may be important to longer working lives.
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Affiliation(s)
- Leah R Abrams
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Kristen Harknett
- Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Schneider
- Kennedy School of Government and Department of Sociology, Harvard University, Cambridge, MA, USA
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Qvist JY, Jensen PH. The retention of older employees and core work activities: Evidence from Denmark. Gerontologist 2022; 62:1071-1081. [PMID: 35023544 DOI: 10.1093/geront/gnac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Retention of older employees in the labour market is crucial to cope with ageing populations. Retention of older employees can appear in different forms, such as phased retirement, bridge jobs, career development, or health promotion. However, little is known about how the offering of these retention strategies may vary across workplaces with different core work activities because the opportunities to implement different types of retention strategies are preconditioned by differences in the economic and labour market climate. RESEARCH DESIGN AND METHODS The study utilises data from a survey conducted among Danish workplaces in 2018, which is linked to administrative register data to conduct KHB-corrected logistic regression models. The study distinguishes among production workplaces, service and welfare workplaces, and information workplaces. RESULTS Phased retirement is most prevalent in service and welfare workplaces, whereas job bridging is most prevalent in both service and welfare and production workplaces. Career development and health promotion strategies are most prevalent in information workplaces. These retention differences between workplaces with different core work activities are in most cases explained by differences in trade union influence, physical working demands, and knowledge intensity. DISCUSSION AND IMPLICATIONS Although the type of retention strategy offered in the workplace largely matches the core work activity within the workplace, particularly production workplaces could feasibly take more advantage of using career development or health promotion strategies since the employees of these workplaces are more likely to retire early due to poor health and physical working conditions.
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Affiliation(s)
| | - Per H Jensen
- Department of Politics and Society, Aalborg University, Aalborg East, Denmark
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Geese F, Zwakhalen S, Lucien B, Hahn S. Job satisfaction of advanced practice nurses in cancer care: A systematic review. Eur J Oncol Nurs 2021; 56:102089. [PMID: 35033880 DOI: 10.1016/j.ejon.2021.102089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/03/2021] [Accepted: 12/18/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To identify, evaluate, and summarise evidence about advanced practice nurses' (APNs') job satisfaction in cancer care and its related factors. METHODS A systematic review was performed including a narrative synthesis. Relevant evidence was identified from searches of three databases: Medline (PubMed), EBSCO (CINAHL), and PsychInfo. This systematic review searched for relevant articles published in English between 2000 and 2020. A structured process according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was followed. The articles critical appraisal was based on the Mixed-Methods Appraisal Tool. Narrative data synthesis was based on the extracted data (study characteristics, type of questionnaire, level of job satisfaction, related factors, and risk of bias). RESULTS Just four articles met the inclusion criteria and were included in the systematic review. Job satisfaction of APNs providing cancer care in different care settings varied from low to high. Satisfying factors were personal, role, work, and institutional factors, whereas dissatisfies included the work setting and stress factors. Different measurement tools of the job satisfaction level were used, which might lead to non-comparable results. CONCLUSION The number of included studies and the findings from this systematic review present underinvestigated content according to the influence of patient group demands on APNs' job satisfaction. Evidence of patient group-specific factors relevant to APNs' job satisfaction could not be found. Further research is needed to address the influence of advanced nursing practice and patient group-related factors on job satisfaction.
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Affiliation(s)
- F Geese
- Academic-Practice-Partnership, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
| | - S Zwakhalen
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands and Living Lab in Ageing and Long-Term Care, Maastricht University, Maastricht, the Netherlands
| | - B Lucien
- Centre of Interprofessional Simulation, Haute école de Santé, Geneva, Switzerland
| | - S Hahn
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Manchha AV, Walker N, Way KA, Dawson D, Tann K, Thai M. Deeply Discrediting: A Systematic Review Examining the Conceptualizations and Consequences of the Stigma of Working in Aged Care. Gerontologist 2021; 61:e129-e146. [PMID: 33103188 DOI: 10.1093/geront/gnaa166] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The stigma of working in aged care can discredit and devalue those working in gerontology. This overlooked workforce issue may underpin complex staffing challenges like chronic worker shortages and inadequate care delivery. Our review synthesizes the existing literature and introduces a conceptual framework based on linguistics to reconcile disparate conceptualizations and negative consequences of this stigma. RESEARCH DESIGN AND METHODS We conducted a systematic review and assessed peer-reviewed articles published from 1973 to 2019 across 5 databases. Fifty-nine articles were selected based on criteria grounded in stigma theory. RESULTS Only 10 articles explicitly used the term "stigma" when conceptualizing the stigma of working in aged care. An additional 49 articles conceptualized this stigma in terms of stigma processes (e.g., status loss). Findings from a deeper examination using a linguistic analysis revealed societal groups predominantly conceptualized stigma in 3 distinct ways based on (a) unfavorable character judgment of aged care workers, (b) lower value placed on aged care work, and (c) negative emotional reactions towards working in aged care. Last, stigma was associated with adverse psychological and job-related consequences. DISCUSSION AND IMPLICATIONS Reconceptualizing this workforce issue and recognizing it as a societal challenge will enable policymakers to design evidence-based interventions at industry and societal levels. We propose workforce challenges in the aged care sector such as attraction, retention, and well-being may lessen with interventions aimed at mitigating the stigma of working in aged care.
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Affiliation(s)
- Asmita V Manchha
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Nicole Walker
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Kïrsten A Way
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Danielle Dawson
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Ken Tann
- The University of Queensland Business School, Brisbane, Australia
| | - Michael Thai
- School of Psychology, The University of Queensland, Brisbane, Australia
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Abstract
Nearly 4.6 million direct care workers-including personal care aides, home health aides, and nursing assistants-provide daily support to older adults and people with disabilities across a range of settings in the United States, predominantly in long-term care (LTC). Even as the population grows older and drives up demand for LTC, the sector continues its decades-long struggle to fill direct care positions and stabilize this essential workforce. Recent events and emerging trends have converged, however, to produce new opportunities to address this longstanding workforce crisis, including the unprecedented attention generated by the coronavirus disease 2019 (COVID-19) pandemic and the systemic shifts to managed care and value-based payment in LTC. This Forum article outlines the pressing direct care workforce challenges in LTC before describing these potential levers of change, emphasizing the importance of not just expanding the workforce but also maximizing direct care workers' contributions to the delivery of high-quality services for a growing and evolving population of LTC consumers.
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Wu SC, Peng MC, Hsueh JY, Chiang TL, Tu YK, Tung YC, Chen YM. Impact of a New Home Care Payment Mechanism on Growth of the Home Care Workforce in Taiwan. Gerontologist 2021; 61:505-516. [PMID: 33491078 DOI: 10.1093/geront/gnab010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Taiwan implemented its first National 10-Year Long-Term Care Plan in 2008 and its second in 2017. Over the first 10 years, the number of home care workers grew too slowly to meet demand. To increase the home care workforce, the government introduced 2 new payment mechanisms in 2018. This study assesses these mechanisms' impact on growth in numbers of home care workers and use of home care services in Taiwan. RESEARCH DESIGN AND METHODS Data were collected from the Ministry of Health and Welfare (2014-2019) and the Division of Long-Term Care (2017-2019). Generalized estimating equations compared rates of growth in the number of home care, institutional care, and foreign care workers and the number of care recipients receiving care from each group before and after 2018. RESULTS Before 2018, rates of growth in all three groups of care workers increased slowly. After 2018, the rate of growth for home care workers increased to 31.8% from 9%, while growth in the other two groups remained stable. While there was greater workforce growth among home care than institutional care workers post-implementation of the payment mechanisms (p < .05), the number of home care recipients (p < .05) and monthly home care visits (p < .05) also increased. DISCUSSION AND IMPLICATIONS The new payment mechanisms improved home care workers' autonomy and salaries and appear to have contributed to immediate increased recruitment and retention. Whether this increase continues over the long run will need to be determined.
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Affiliation(s)
- Shih-Cyuan Wu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | | | - Tung-Liang Chiang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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15
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Ludlow K, Churruca K, Mumford V, Ellis LA, Testa L, Long JC, Braithwaite J. Unfinished Care in Residential Aged Care Facilities: An Integrative Review. Gerontologist 2021; 61:e61-e74. [PMID: 31773131 DOI: 10.1093/geront/gnz145] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES When workload demands are greater than available time and resources, staff members must prioritize care by degree of importance and urgency. Care tasks assigned a lower priority may be missed, rationed, or delayed; collectively referred to as "unfinished care." Residential aged care facilities (RACFs) are susceptible to unfinished care due to consumers' complex needs, workforce composition, and constraints placed on resource availability. The objectives of this integrative review were to investigate the current state of knowledge of unfinished care in RACFs and to identify knowledge gaps. RESEARCH DESIGN AND METHODS We conducted a search of academic databases and included English-language, peer-reviewed, empirical journal articles that discussed unfinished care in RACFs. Data were synthesized using mind mapping techniques and frequency counts, resulting in two categorization frameworks. RESULTS We identified 17 core studies and 27 informing studies (n = 44). Across core studies, 32 types of unfinished care were organized under five categories: personal care, mobility, person-centeredness, medical and health care, and general care processes. We classified 50 factors associated with unfinished care under seven categories: staff member characteristics, staff member well-being, resident characteristics, interactions, resources, the work environment, and delivery of care activities. DISCUSSION AND IMPLICATIONS This review signifies that unfinished care in RACFs is a diverse concept in terms of types of unfinished care, associated factors, and terminology. Our findings suggest that policymakers and providers could reduce unfinished care by focusing on modifiable factors such as staffing levels. Four key knowledge gaps were identified to direct future research.
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Affiliation(s)
- Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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16
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Kennedy KA, Applebaum R, Bowblis JR. Facility-Level Factors Associated With CNA Turnover and Retention: Lessons for the Long-Term Services Industry. Gerontologist 2021; 60:1436-1444. [PMID: 32726449 DOI: 10.1093/geront/gnaa098] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Certified nursing assistant (CNA) turnover and retention are critical aspects of facilities' ability to provide cost-effective, high-quality person-centered care. Previous studies and industry practice often treat turnover and retention as similar concepts, assuming that low turnover and high retention are synonymous. The study addressed the question of whether turnover and retention rates differ and if so, what those differences mean for nursing home practice, policy, and research. RESEARCH DESIGN AND METHODS This study examines facility-level factors associated with CNA retention and turnover rates using 2015 data from the Ohio Biennial Survey of Long-Term Care Facilities, Ohio Medicaid Cost Reports, Certification and Survey Provider Enhanced Report, and the Area Health Resource File. Using bivariate tests and regression analysis, we compare rates and the factors associated with retention and turnover. RESULTS The mean facility annual retention rate was 64% and the mean annual turnover rate was 55%. As expected, there was a statistically significant and negative correlation between the rates (r = -0.26). However, some facilities had both high retention and high turnover and some had low rates for both measures. Not all the variables that are associated with turnover are also associated with retention. DISCUSSION AND IMPLICATIONS CNA retention is not simply the absence of CNA turnover. Given the differences, nursing homes may need to use strategies and policies designed to target a particular stability measure.
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Affiliation(s)
| | | | - John R Bowblis
- Scripps Gerontology Center, Miami University, Oxford, Ohio.,Department of Economics, Farmer School of Business, Miami University, Oxford, Ohio
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17
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Hassmiller SB. Legacies And Lessons: A Final Conversation With Fitzhugh Mullan. Health Aff (Millwood) 2020; 39:334-338. [PMID: 32011947 DOI: 10.1377/hlthaff.2019.01715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The late academic, physician, policy maker, and writer discusses his career achievements, lessons for the future, and cancer.
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Affiliation(s)
- Susan B Hassmiller
- Susan B. Hassmiller ( shassmiller@rwjf. org ) is the senior adviser for nursing at the Robert Wood Johnson Foundation, in Princeton, New Jersey
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18
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to demonstrate how a remote workforce may increase access to care while reducing physician burnout. We review workforce issues and organizational and individual obstacles for implementing a telepsychiatry workforce including administrative, logistical, and clinical considerations and offer resources for how to overcome barriers that may arise in implementing a remote workforce. RECENT FINDINGS There is an increasingly unmet demand for mental health services and a shortage in psychiatrists. Burnout may be a key factor contributing to psychiatrists working less, pursuing less acute cases, and leading to worsened outcomes for patients and the psychiatrists themselves. Telepsychiatry provides comparable patient and provider satisfaction and equal outcomes when compared with face-to-face encounters. We provided 3 case examples to demonstrate psychiatrists demonstrating successful delivery of care in a range of clinic settings and workplace configurations while optimizing their quality of life and reducing their risk of burnout.
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Affiliation(s)
| | - Brittany E Plaven
- Walden University, Minneapolis, USA.,Department of Health Professions, Metropolitan State University of Denver, Denver, USA
| | | | - Jay H Shore
- AccessCare, 11100 E. Bethany Dr., Aurora, CO, 80014, USA.,Department of Psychiatry and Family Medicine, School of Medicine, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, USA
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19
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Abstract
Shortages in nursing are the single biggest and most urgent workforce issue that the NHS needs to address. This article sets out the early success of the Nurse Clinical Fellowship Programme established by The Royal Wolverhampton NHS Trust. The unique programme aims to attract and retain nurses by offering a staff nurse post with supported access to academia, fully funded by the NHS Trust. To date, the Trust has attracted 90 nurses (both UK and international registered nurses) to the programme. The programme is also offered internally and the Trust has a cohort of 10 internal nursing staff enrolled onto the programme completing either their BSc (top-up) or Masters, with a second cohort of 60 internal nurses due to start in September 2019. To support international registered nurses with demonstrating their competence to meet Nursing and Midwifery Council requirements the Trust has also established an objective structured clinical examination preparation course designed to embrace and enhance the existing knowledge and skills, while guiding staff in transferring these in line with UK and Trust policies and practices.
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Affiliation(s)
- Zoe Marsh
- Acting Head of Education and Clinical Fellowship Programme Manager, The Royal Wolverhampton NHS Trust
| | - Leanne Walford
- Practice Education Facilitator, The Royal Wolverhampton NHS Trust
| | | | - Ann-Marie Cannaby
- Chief Nurse, The Royal Wolverhampton NHS Trust / Professor of Nursing Sciences, Birmingham City University
| | - Baldev M Singh
- Consultant, The Royal Wolverhampton NHS Trust/Medical Director, School of Medicine and Clinical Practice, University of Wolverhampton
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20
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Kang JY, Park S, Kim B, Kwon E, Cho J. The Effect of California's Paid Family Leave Program on Employment Among Middle-Aged Female Caregivers. Gerontologist 2019; 59:1092-1102. [PMID: 30265297 DOI: 10.1093/geront/gny105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined the effect of a Paid Family Leave program in California (CA-PFL) on employment among middle-aged female caregivers. We also examined differences in the relationship between the availability of paid family leave (PFL) and employment in socioeconomic subgroups of midlife women. RESEARCH DESIGN AND METHODS Data came from multiple years (2000‒2014) of the Current Population Survey (CPS) (N = 68,773 individuals). Applying a Difference in Differences (DiD) approach to removing potential selection biases related to program participation, we used a logistic regression to estimate the effects of PFL. RESULTS There was a significant increase in the likelihood of working based on CA-PFL. This positive effect, however, was found only among the early middle-aged, the near-poor, and those had the highest level of education. DISCUSSION AND IMPLICATIONS Among the late middle-aged, caregiving burden may not affect decisions on whether to exit the labor market, and PFL may not significantly mitigate the well-known negative effects of intense and multiple caregiving roles (parents, spouse, and/or children with disabilities). Future studies should examine PFL effects and their correlates such as age-cohorts, caregiving intensity, and retirement patterns. The unexpected null findings of CA-PFL's effect on employment outcomes for the poor and those with low education levels suggests these vulnerable groups might not be able to fully benefit from the originally intended goal of the policy, instead being left more vulnerable compared to the near poor. Such a possibility increases the importance of focused research and policymaking attention for this group.
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Affiliation(s)
- Ji Young Kang
- West Coast Poverty Center, University of Washington, Seattle
| | - Sojung Park
- George Warren Brown School of Social Work, Washington University in St. Louis, Missouri
| | - BoRin Kim
- Department of Social Work, University of New Hampshire, Durham
| | - Eunsun Kwon
- Department of Social Work, St. Cloud State University, Minnesota
| | - Joonyoung Cho
- School of Social Work, University of Michigan, Ann Arbor
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21
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Muramatsu N, Yin L. Gentle Physical Activity Intervention Led by Caregivers in a Medicaid Home Care Program: Do Outcomes Differ Between Family and Nonfamily Caregiving Dyads? Innov Aging 2019; 3:igz034. [PMID: 31528715 PMCID: PMC6736161 DOI: 10.1093/geroni/igz034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Indexed: 01/05/2023] Open
Abstract
Background and Objectives Caregiving dyads are fertile contexts for health promotion such as physical activity. However, previous physical activity interventions in caregiving dyads paid limited attention to care recipients’ outcomes and rarely involved paid caregivers. Home care aides (HCAs) provide nonmedical care for older family members or nonfamily clients in publicly funded home care programs in the United States. This study examined whether family and nonfamily HCA–client dyads differed in the outcomes of a 4-month gentle physical activity pilot program led by HCAs in a Medicaid home care program. Design and Methods A single-group prepost design was used to assess changes in clients’ function (self-reported and performance-based) and process outcomes (exercise-related social support provided by HCAs) in 18 family and 32 nonfamily HCA–client dyads. Repeated measures analysis controlled for clients’ demographic and health characteristics. Clients’ and HCAs’ motivation to continue the program beyond the intervention period was examined using quantitative and qualitative data. Results Client outcomes and exercise-related social support provided by HCAs improved, especially in nonfamily dyads. Both family and nonfamily dyads had high levels of motivation to continue the program, supporting the program’s sustainability for both clients and HCAs. Discussion and Implications Empowering HCAs to engage in health promoting activities with their clients is a promising strategy to improve the lives of caregiving dyads.
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Affiliation(s)
- Naoko Muramatsu
- School of Public Health, University of Illinois at Chicago.,Institute for Health Research and Policy, University of Illinois at Chicago
| | - Lijuan Yin
- School of Public Health, University of Illinois at Chicago.,Institute for Health Research and Policy, University of Illinois at Chicago
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22
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Tchernegovski P, Hine R, Reupert AE, Maybery DJ. Adult mental health clinicians' perspectives of parents with a mental illness and their children: single and dual focus approaches. BMC Health Serv Res 2018; 18:611. [PMID: 30081896 PMCID: PMC6080541 DOI: 10.1186/s12913-018-3428-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/30/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND When clinicians in the adult mental health sector work with clients who are parents with dependent children, it is critical they are able to acknowledge and respond to the needs of the parents and their children. However, little is known about clinicians' personal perspectives and reactions towards these parents and children or if/how they balance the needs of both. METHODS Semi structured interviews were conducted with eleven clinicians from adult mental health services in Australia. Interviews focused on clinicians' experiences when working with parents who have mental illness. Transcripts were analysed within an Interpretative Phenomenological Analysis framework to examine participants' perspectives and personal reactions to parents and children. RESULTS There was considerable divergence in participants' reactions towards parents and children and the focus of their perspectives when working with parental mental illness. Feelings of sympathy and responsibility made it difficult for some participants to maintain a dual focus on parents and children and contributed to some adopting practices that focused on the needs of parents (n = 3) or children (n = 1) exclusively. Other participants (n = 7) described strategies and supports that allowed them to manage these feelings and sustain a dual focus that incorporated the experiences and needs of both parents and children. CONCLUSIONS It is difficult for some mental health clinicians to maintain a dual focus that incorporates the needs and experiences of parents and their children. However, findings suggest that the challenges of a dual focus may be mitigated through adequate workplace support and a strengths-based practice framework that emphasises parental empowerment.
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Affiliation(s)
- Phillip Tchernegovski
- Krongold Clinic, Faculty of Education, Monash University, Clayton Campus, Melbourne, VIC 3800 Australia
| | - Rochelle Hine
- South West Healthcare, Ryot Street, Warrnambool, VIC 3280 Australia
| | - Andrea E. Reupert
- Krongold Clinic, Faculty of Education, Monash University, Clayton Campus, Melbourne, VIC 3800 Australia
| | - Darryl J. Maybery
- Department of Rural and Indigenous Health, School of Rural Health, Monash University, PO Box 973, Moe, VIC 3825 Australia
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23
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Gamzu R, Kaidar N, Afek A, Horev T. Physician density planning in a public healthcare system: Complexities, threats and opportunities-The case of the Israeli healthcare system. Health Policy 2016; 120:920-7. [PMID: 27496154 DOI: 10.1016/j.healthpol.2016.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 11/22/2022]
Abstract
Human-resource planning in healthcare is one of the most significant challenges that healthcare systems worldwide face. Among all healthcare professions, the planning of physician supply is the most complex of all due to physicians' lengthy training and many specialties. Forecasts showing a disturbing downward trend in the ratio of physicians to population in Israel prompted the Israeli Government in 2010 to establish a committee mandated to predict demand for physicians and recommend steps to adjust supply to it. The committee analyzed numerous variables that affect physician supply and demand and recommended measures that in greater part were implemented. The article discusses the methodology of the committee, its recommendations, and their implementation such as a 52% increase in the number of first-year medical students between 2010 and 2012. Its analysis of the current situation shows that the implementation of the recommendations successfully stemmed the decrease in physician density and attained the committee's other long-term objectives: physician density of 2.9 per 1000 of population and an increase (32.5%) in the number of physicians who began training in targeted specialties.
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24
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Galik E, Resnick B, Lerner N, Hammersla M, Gruber-Baldini AL. Function Focused Care for Assisted Living Residents With Dementia. Gerontologist 2016; 55 Suppl 1:S13-26. [PMID: 26055774 DOI: 10.1093/geront/gnu173] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY Assisted living (AL) residents with dementia require assistance with activities of daily living, encounter limited opportunities to engage in physical activity, and often exhibit challenging behavioral symptoms. The Function Focused Care Intervention for the Cognitively Impaired (FFC-CI) teaches and motivates direct care workers (DCWs) to engage residents with dementia in activities that optimize function and activity while minimizing behavioral symptoms. The purpose of this study was to test the impact of FFC-CI on function, physical activity, behavior, and falls. DESIGN AND METHODS A cluster-randomized trial included 96 residents with dementia and 76 DCWs from 4 ALs. Generalized estimating equations were used to evaluate outcomes at 3 and 6 months. RESULTS There were no treatment by time differences with regard to resident behavior, mood, counts of physical activity based on actigraphy, falls, and function. There were significant increases in physical activity based on kilocalories burned (p = .001), time spent in physical activity based on survey results (p = .001), and time spent in repetitive behaviors, such as wandering (p = .01) among the control group over time. There were no treatment by time differences with regard to DCW beliefs, knowledge, or performance of FFC, except for less decline in job satisfaction among the treatment group (p = .002). Treatment fidelity with regard to delivery and receipt were poor due to high staff attrition in the treatment group (46% vs. 16%) and limited site support. IMPLICATIONS The findings from this study can be used to adapt future FFC intervention studies to improve treatment fidelity and optimize intervention efficacy.
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Affiliation(s)
- Elizabeth Galik
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland.
| | - Barbara Resnick
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Nancy Lerner
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Margaret Hammersla
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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25
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Kuokkanen L, Leino-Kilpi H, Numminen O, Isoaho H, Flinkman M, Meretoja R. Newly graduated nurses' empowerment regarding professional competence and other work-related factors. BMC Nurs 2016; 15:22. [PMID: 27013927 PMCID: PMC4806465 DOI: 10.1186/s12912-016-0143-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Although both nurse empowerment and competence are fundamental concepts of describing newly graduated nurses’ professional development and job satisfaction, only few studies exist on the relationship between these concepts. Therefore, the purpose of this study was to determine how newly graduated nurses assess their empowerment and to clarify professional competence compared to other work-related factors. Methods A descriptive, cross-sectional and correlational design was applied. The sample comprised newly graduated nurses (n = 318) in Finland. Empowerment was measured using the 19-item Qualities of an Empowered Nurse scale and the Nurse Competence Scale measured nurses’ self-assessed generic competence. In addition to demographic data, the background data included employment sector (public/private), job satisfaction, intent to change/leave job, work schedule (shifts/business hours) and assessments of the quality of care in the workplace. The data were analysed statistically by using Spearman’s correlation coefficient as well as the One-Way and Multivariate Analysis of Variance. Cronbach’s alpha coefficient was used to estimate the internal consistency. Results Newly graduated nurses perceived their level of empowerment and competence fairly high. The association between nurse empowerment and professional competence was statistically significant. Other variables correlating positively to empowerment included employment sector, age, job satisfaction, intent to change job, work schedule, and satisfaction with the quality of care in the work unit. The study indicates competence had the strongest effect on newly graduated nurses’ empowerment. Conclusions New graduates need support and career opportunities. In the future, nurses’ further education and nurse managers’ resources for supporting and empowering nurses should respond to the newly graduated nurses’ requisites for attractive and meaningful work.
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Affiliation(s)
- Liisa Kuokkanen
- Helsinki University Hospital, Finland, Corporate Headquarters, Henkivartijantie 18, FI-000620 Helsinki, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, Turku University Hospital, University of Turku, Turku, Finland
| | - Olivia Numminen
- Helsinki University Hospital, Finland, Corporate Headquarters, Henkivartijantie 18, FI-000620 Helsinki, Finland
| | | | - Mervi Flinkman
- Helsinki University Hospital, Finland, Corporate Headquarters, Turku, Finland ; University of Turku, Department of Nursing Science, Turku, Finland
| | - Riitta Meretoja
- Helsinki University Hospital, Finland, Corporate Headquarters, Turku, Finland ; University of Turku, Department of Nursing Science, Turku, Finland
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Trede F, Sutton K, Bernoth M. Conceptualisations and perceptions of the nurse preceptor's role: A scoping review. Nurse Educ Today 2016; 36:268-274. [PMID: 26276530 DOI: 10.1016/j.nedt.2015.07.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/21/2015] [Accepted: 07/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The practice of nursing is a substantially different undertaking to supervising nursing students. A clear conceptualisation of the preceptor role reveals its scope, expectations and responsibilities. The aim of this scoping review is to investigate what is known in the pertinent literature about preceptors' experiences of their supervision practices and their perceptions of what makes a good workplace environment that enables good preceptorship and is conducive to student learning. DESIGN AND DATA SOURCES The literature scoping review design by Arksey and O'Malley was adopted for this literature review study because it enables researchers to chart, gather and summarise known literature on a given topic. Databases searched included Scopus, Ebsco, Informit and VOCEDplus. REVIEW METHOD To answer our research question what is known about how undergraduate nursing student preceptors' supervision practices are conceptualised and perceived we posed four analysis questions to our literature set: (1) How do the articles conceptualise preceptorship? (2) What pedagogical frameworks are used to understand preceptorship? (3) What are the messages for preceptorship practices? (4) What are the recommendations for future research? RESULTS A total of 25 articles were identified as eligible for this study. The results are ordered into four sections: theoretical conceptualisations of the preceptorship role, pedagogical framework, messages about preceptoring and recommendations for further research. CONCLUSION The discourse of preceptorship is not underpinned by a strong theoretical and pedagogical base. The role of preceptors has not been expanded to include theoretical perspectives from socio-cultural practice and social learning paradigms.
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Affiliation(s)
- Franziska Trede
- Education for Practice Institute, Department of Student Learning, Charles Sturt University, Australia.
| | - Katelin Sutton
- Education for Practice Institute, Department of Student Learning, Charles Sturt University, Australia.
| | - Maree Bernoth
- School of Nursing, Midwifery, & Indigenous Health, Faculty of Science, Charles Sturt University, Australia.
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27
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Graf E, Cignacco E, Zimmermann K, Zúñiga F. Affective Organizational Commitment in Swiss Nursing Homes: A Cross-Sectional Study. Gerontologist 2015; 56:1124-1137. [PMID: 26035877 DOI: 10.1093/geront/gnv053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/18/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY This substudy of the Swiss Nursing Homes Human Resources Project (SHURP) explored the relationships between affective organizational commitment (AOC) levels and organizational, situational, and care personnel characteristics, and between AOC and care personnel outcomes. DESIGNS AND METHODS SHURP was a representative national cross-sectional study in 163 Swiss nursing homes. Its data sources were: (a) a care personnel questionnaire, (b) a facility questionnaire, (c) a unit questionnaire, and (d) administrative resident data. Generalized estimating equations (GEEs) were applied to examine AOC's relationships with selected antecedents and care personnel outcomes. RESULTS Data were collected from 5,323 care personnel in 163 nursing homes (return rate: 76%). On a scale from 1 to 5, the mean level of AOC was 3.86 (standard deviation = 0.81). Variations in AOC regarding care personnel characteristics (age, education, and experience in nursing home) and organizational characteristics (size, profit status) were statistically significant with minimal effect sizes. The main factors positively related to AOC were leadership, job satisfaction, quality of care, and collaboration with the nursing home director. Care personnel outcomes significantly related to higher AOC were reduced intention to leave, health complaints, presenteeism, and absenteeism. IMPLICATIONS As leadership is a crucial factor of AOC, its development might improve care personnel outcomes such as intention to leave or absenteeism.
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Affiliation(s)
- Elisabeth Graf
- Institute of Nursing Science, University of Basel, Switzerland
| | - Eva Cignacco
- Institute of Nursing Science, University of Basel, Switzerland
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28
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Simon MA, Gunia B, Martin EJ, Foucar CE, Kundu T, Ragas DM, Emanuel LL. Path toward economic resilience for family caregivers: mitigating household deprivation and the health care talent shortage at the same time. Gerontologist 2013; 53:861-73. [PMID: 23633216 DOI: 10.1093/geront/gnt033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Rising costs and a workforce talent shortage are two of the health care industry's most pressing challenges. In particular, serious illnesses often impose significant costs on individuals and their families, which can place families at an increased risk for multigenerational economic deprivation or even an illness-poverty trap. At the same time, family caregivers often acquire a wide variety of health care skills that neither these caregivers nor the health care industry typically use. As these skills are marketable and could be paired with many existing medical certifications, this article describes a possible "path toward economic resilience" (PER) through a program whereby family caregivers could find meaningful employment using their new skills. The proposed program would identify ideal program candidates, assess and supplement their competencies, and connect them to the health care industry. We provide a set of practical steps and recommended tools for implementation, discuss pilot data on the program's appeal and feasibility, and raise several considerations for program development and future research. Our analysis suggests that this PER program could appeal to family caregivers and the health care industry alike, possibly helping to address two of our health care system's most pressing challenges with one solution.
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Affiliation(s)
- Melissa A Simon
- *Address correspondence to Melissa A. Simon, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine; 633 N. St. Clair, Suite 1800, Chicago, IL 60611. E-mail:
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Abstract
PURPOSE This article expands on earlier analyses that assessed whether the recent recession influenced retirement expectations. DESIGN AND METHODS Acknowledging that planning for retirement is a complex process influenced by personal preferences, resources, economic factors, institutional policies, and social norms, we test more comprehensive models than those used in previous studies, using data from the 2006 and 2008 waves (Waves 8 and 9) of the Health and Retirement Study. RESULTS Our results confirm that economic changes impinge on retirement expectations, but they also show stronger influences of other factors such as debts and the work environment. IMPLICATIONS As the baby boom cohorts approach retirement age, it will be important to better understand how workers consider macro factors such as the state of the economy and firm-level factors and personal finances when planning for retirement.
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Affiliation(s)
- Maximiliane E Szinovacz
- *Address correspondence to Maximiliane E. Szinovacz, Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125. E-mail:
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