Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study

INTRODUCTION

Our objective was to identify factors associated with episiotomy practice in France, in particular, characteristics of the maternity units and regions of delivery.

MATERIAL AND METHODS

We performed a national cross-sectional population-based study in all French maternity units in 2016 including 9284 women with vaginal delivery. Our outcome was the performance of an episiotomy. After stratification for parity, associations of episiotomy practice with individual and organizational characteristics and the region of delivery were estimated with multilevel logistic regression models. The variability in maternity unit episiotomy rates explained by the characteristics studied was estimated by the proportional change in variance.

RESULTS

A total of 19.9% of the women had an episiotomy. The principal factors associated with episiotomy practice were maternal and obstetric and delivery in a maternity unit with <2000 annual deliveries. After adjusting for individual, obstetric and organizational characteristics, the practice of episiotomy was strongly associated with women's region of delivery. Additionally, women's individual characteristics did not explain the significant variability in episiotomy rates between maternity units (P < 0.001) but maternity unit characteristics partly did (proportion of variance explained: 7.2% for primiparas and 13.6% for multiparas) and regional differences still more (18% and 30.7%, respectively).

CONCLUSIONS

Episiotomy practices in France in 2016 varied strongly between maternity units, largely due to regional differences. Targeted actions by the regional perinatal care networks may reduce the national episiotomy rate and standardize practices.

Impact of organizational characteristics on employees' entrepreneurial orientation with mediating role of knowledge process capabilities and moderating role of psychological factors in the era of COVID-19

Purpose

The study aims to investigate the impact of organizational characteristics and knowledge process capabilities on the entrepreneurial orientation among the manufacturing industry employees in the Punjab province of Pakistan. Additionally, this study has examined the mediating role of knowledge process capabilities in the relationship between organizational characteristics and entrepreneurial orientation among those employees and the moderating effect of psychological factors on the relationship between organizational characteristics and entrepreneurial orientation.

Design methodology and approach

The study has employed the survey-based methodology and data are collected with the aid of self-administered questionnaires. This study utilized the partial least squares structural equation modeling (PLS-SEM) to establish the validity and reliability of the measurement model and test the relationships. The response rate of the current study is 64.66%.

Findings

The study findings have shown mixed results as one of the organizational characteristics, namely, resource and time availability is an insignificant determinate of entrepreneurial orientation among the manufacturing industry employees in Punjab province of Pakistan. Whereas management support, rewards, work discretion, and knowledge process capabilities appear as significant determinates of employees' entrepreneurial orientation. The results indicated that knowledge process capabilities have a mediating role in the relationship between organizational characteristics and employees' entrepreneurial orientation. Moreover, psychological factors, namely, propensity to take risk and locus of control have a significant moderating role on the relationship of management support, rewards, and work discretion with employees' entrepreneurial orientation.

Practical implications

The empirical insights on the study are valuable for policymakers and managers in manufacturing sectors of developing countries, such as Pakistan, to enrich their work performance through the understanding impact of organizational characteristics and knowledge process capabilities on the entrepreneurial orientation with moderating role of psychological factors.

Originality and value

Studies on the mediating impact of knowledge process capabilities on the linkage between organizational characteristics and entrepreneurial orientation with the moderating role of psychological factors remain limited. This study is one of the earliest studies that investigate these inter-relationships.

Testing a model of Thai nurses' intent to stay in employment

AIM

To test the causal model of intent to stay in employment of nurses in regional medical centers.

BACKGROUND

Effectiveness and quality of nursing care are determined by an adequate number of nursing staff; however, there is an ongoing challenge of nursing shortage. Improving nurses' intention to remain in employment is an effective way to address the problem of nursing shortage.

METHODS

This study employed a cross-sectional design. The sample was 1224 registered nurses from nine regional medical centers across Thailand, selected using multistage random sampling. Data were collected between January and July 2019 and analyzed with structural equation modeling.

RESULTS AND DISCUSSION

The final model could explain 40.3% of the variance in intent to stay. Transformational leadership, coworker support, professional autonomy, opportunities for promotion, marital status, and job satisfaction positively affected intent to stay, while burnout negatively affected intent to stay. This indicates that seven factors that should be considered by nurse managers in developing a framework for constructing interventions to increase nurses' intention to continue working in their organization.

IMPLICATION FOR NURSING AND NURSING POLICY

Nurse managers should strengthen the intent to stay of nurses by providing consultations, building a positive work atmosphere, and encouraging nurse leaders to apply transformational leadership behaviors to the organizational administration. Policymakers should consider enacting policies and regulations for nurses' benefits, such as allocating civil servant positions to temporary nursing staff, expanding the framework of career advancement to a senior professional position, and considering salary and overtime pay, to increase nurses' intent to stay in an organization.

Teleworking, Work Engagement, and Intention to Quit during the COVID-19 Pandemic: Same Storm, Different Boats?

The ability to retain and engage employees is now, more than ever, a major strategic issue for organizations in the context of a pandemic paired with a persistent labor shortage. To this end, teleworking is among the work organization conditions that merit consideration. The purpose of this cross-sectional study is to examine the direct and indirect effects of teleworking on work engagement and intention to quit, as well as the potential moderating effect of organizational and individual characteristics on the relationship between teleworking, work engagement, and intention to quit during the COVID-19 pandemic, based on a sample of 254 Canadian employees from 18 small and medium organizations. To address these objectives, path analyses were conducted. Overall, we found that teleworking, use of emotion, skill utilization, and recognition appear to be key considerations for organizations that wish to increase work engagement and decrease intention to quit, in the context of a pandemic paired with a labor shortage. Our results extend the literature by revealing the pathways through which teleworking, use of emotion, skill utilization, and recognition are linked to work engagement and intention to quit, and by suggesting specific interventions and formation plans that are needed.

Hospitalists, two decades later: Which US hospitals utilize them?

Hospitalists, or specialists of hospital medicine, have long been practicing in Canada and Europe. However, it was not until the mid-1990s, when hospitals in the U.S. started widespread adoption of hospitalists. Since then, the number of hospitalists has grown exponentially in the U.S. from a few hundred to over 50,000 in 2016. Prior studies on hospitalists have well documented benefits hospitals gain from adopting this innovative staffing strategy. However, there is a dearth of research documenting predictors of hospitals' adoption of hospitalists. To fill this gap, this longitudinal study (2003-2015) purposes to determine organizational and market characteristics of U.S. hospitals that utilize hospitalists. Our findings indicate that private not-for-profit, system affiliated, teaching, and urban hospitals, and those located in higher per capita income markets have a higher probability of utilizing hospitalists. Additionally, large or medium, profitable hospitals, and those that treat sicker patients have a higher probability of adoption. Finally, hospitals with a high proportion of Medicaid patients have a lower probability of utilizing hospitalists. Our results suggest that hospitals with greater slack resources and those located in munificent counties are more likely to use hospitalists, while their under-resourced counterparts may experience more barriers in adopting this innovative staffing strategy.

Nurses' views on hospital organizational characteristics

BACKGROUND

Positive organizational characteristics are conducive to healthy work environments. Hospitals with positive organizational characteristics and healthy work environments attract nurses. In turn, positive organizational characteristics and healthy work environments in hospitals will result in positive nurse, patient, and organizational outcomes.

AIM

The aim of this study was to assess hospital organizational characteristics from the viewpoint of registered nurses (RNs) in the country of Jordan.

METHODS

The researcher used a survey method to conduct the study; the Revised Nursing Work Index (NWI-R) was used to collect data, utilizing a convenience sample of 308 RNs with a total response rate of 75%.

FINDINGS

The strongest positive hospital organizational characteristic was the presence of adequate support services which allow nurses to spend time with their patients. The strongest negative hospital organizational characteristics were the nursing delivery systems-particularly in primary nursing where they result in nurses having to do things that are against their nursing judgment-and the limited opportunities and freedom over many aspects of nursing care and unit/ward decisions.

CONCLUSIONS

Positive hospital organizational characteristics should be maintained because these produce positive nurse, patient, and organizational outcomes. Fostering a positive hospital organizational environment is a continuous effort. The results have implications for practice, research, and education.

Organizational influences on the intimate partner violence and sexual violence screening practices of college health care providers

Experts and professional organizations in the U.S. have issued recommendations that health care providers (HCPs) should screen women for intimate partner violence (IPV) and sexual violence (SV). Despite the high rates of IPV and SV experienced by female college students, investigators have found that providers are not screening for IPV and SV in college health centers. In this study, a cross-sectional survey design was utilized to: (a) examine college HCPs' reports of IPV/SV screening behaviors and (b) identify the individual-level and organization-level structure and process characteristics that promote or inhibit IPV/SV screening. A total of 773 college HCPs (physicians, nurse practitioners, and registered nurses) were invited to participate in the study using two separate sampling frames. The final sample included 210 college HCPs. Providers reported low rates of IPV/SV screening (median = 20%). Screening rates varied by provider type with nurse practitioners reporting the highest screening rates. Urban location was associated with a three and one-half times greater likelihood of IPV/SV screening. Use of an electronic health record that included a prompt to screen was associated with a three-fold increase in the likelihood that HCPs would screen for IPV/SV. Further study is needed to better understand how organizational factors influence providers' screening behaviors in college health centers and how these influences are mediated. Future studies should include larger and more diverse samples of colleges and examine geographical variations in screening practices.

Increased parental satisfaction by unrestricted visiting hours and developmentally supportive care in NICUs - results of a German multicenter study

Purpose: This study aims to provide insights into the impact of organizational family-centered care characteristics at German neonatal intensive care units (NICUs) on the satisfaction of parents of very low birthweight (VLBW) infants.Materials and methods: Using multilevel modeling, this study analyzed whether organizational characteristics of NICUs fostering parent-infant interaction (by way of the existence of a recreation room, possibility of rooming in, existence of unrestricted visiting hours for parents, existence of parental classes, and the connection to parent associations as well as the existence of standards on developmentally supportive care) increase the satisfaction of parents after the infants' high-intensive care phase within the NICU.Results: Nine hundred and twenty-three VLBW infants from 66 NICUs in Germany born between May and October 2013 were enrolled in this multicenter study. We retrieved 1493 questionnaires completed by 1277 parents. The existence of unrestricted visiting hours (adjusted odds ratio (AOR): 1.967; 95% CI [1.118, 3.459]) and standardized procedures for developmentally supportive care (AOR: 1.775; 95% CI [1.166, 2.704]) were positively associated with parental satisfaction.Conclusions: Fostering the parent-infant interaction through the provision of developmentally supportive care and unrestricted visiting hours for parents whose infants are hospitalized within an NICU significantly contributes to the satisfaction of parents.

The relationship between ethical conflict and nurses' personal and organisational characteristics

INTRODUCTION

Critical care nurses work in a complex and stressful environment with diverse norms, values, interactions, and relationships. Therefore, they inevitably experience some levels of ethical conflict.

AIM

The aim of this study is to analyze the relationship of ethical conflict with personal and organizational characteristics among critical care nurses.

METHODS

This descriptive-correlational study was conducted in 2017 on a random sample of 216 critical care nurses. Participants were recruited through stratified random sampling. Data collection tools were a demographic and professional characteristics questionnaire, the Ethical Conflict in Nursing Questionnaire-Critical Care Version, and the Organizational and Managerial Factors Questionnaire. The data were analyzed using the SPSS software (v. 22.0).

ETHICAL CONSIDERATIONS

All participants were informed about the study's aim and were assured that participation in and withdrawal from the study would be voluntary.

FINDINGS

The mean score of exposure to ethical conflict was 201.91 ± 80.38. The highest-scored conflict-inducing clinical situation was "working with professionally incompetent nurses or nurse assistants." Married nurses, nurses with official employment, nurses with master's degree, and nurses with the history of attending ethics education programs had significantly higher exposure to ethical conflict than the other nurses (p < 0.05). The significant predictors of exposure to ethical conflict were marital status, educational status, reward system, organizational culture, manager's conduct, and organizational structure and regulations (p < 0.05). These predictors accounted for 37.2% of the total variance of exposure to ethical conflict.

CONCLUSION

Critical care nurses experience moderate levels of exposure to ethical conflict. A wide range of personal and organizational factors can contribute to such exposure, the most significant of which is the professional incompetence of nursing colleagues, nurse assistants, and physicians. Therefore, many improvements at personal and organizational levels are needed to reduce critical care nurses' exposure to ethical conflict.

Why Is Bigger Not Always Better in Primary Health Care Practices? The Role of Mediating Organizational Factors

Size of primary health care (PHC) practices is often used as a proxy for various organizational characteristics related to provision of care. The objective of this article is to identify some of these organizational characteristics and to determine the extent to which they mediate the relationship between size of PHC practice and patients’ experience of care, preventive services, and unmet needs. In 2010, we conducted population and organization surveys in 2 regions of the province of Quebec. We carried out multilevel linear and logistic regression analyses, adjusting for respondents’ individual characteristics. Size of PHC practice was associated with organizational characteristics and resources, patients’ experience of care, unmet needs, and preventive services. Overall, the larger the size of a practice, the higher the accessibility, but the lower the continuity. However, these associations faded away when organizational variables were introduced in the analysis model. This result supports the hypothesized mediating effect of organizational characteristics on relationships between practice size and patients’ experience of care, preventive services, and unmet needs. Our results indicate that size does not add much information to organizational characteristics. Using size as a proxy for organizational characteristics can even be misleading because its relationships with different outcomes are highly variable.

An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities

Background

There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital.

Methods

In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses’ perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse–physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined.

Results

Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival.

Conclusions

This study showed that perceived staffing adequacy and nurses’ assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals.

What Are the Ideal Characteristics of Empirically Supported Treatment Adopters?

There has been a clear and consistent shift in social work practice from offering treatment as usual to implementing empirically supported treatments (ESTs). As social work researchers and practitioners continue to evaluate the effectiveness of ESTs, their impact on clinical outcomes, and the various obstacles to their adoption, a developing literature could offer some guidance on characteristics of EST adopters. This article provides a beginning discussion of the ideal characteristics of EST adopters both at the organizational and individual levels. While this is a developing area of study, there are some important findings that could better serve community-based organizations, their work force, and the communities they serve.

Relationships between organizational workplace characteristics and perceived workplace strain in call-centers in France

BACKGROUND

Our objective was to study the associations between organizational workplace characteristics (OC) reported by call-center (CC) managers and workplace stressors reported by call-handlers.

METHODS

The managers of 107 CCs were interviewed by their occupational physicians using a questionnaire designed to specifically explore OC in the CCs. Four thousand two call-handlers from these CCs completed a self-report questionnaire including the Karasek and Siegrist work stressor questionnaires and two specific items on other workplace stressors.

RESULTS

Around one-third of the OC examined were associated with the demand/control ratio, the perception of demanding work and ethical conflicts, however, far fewer OC were associated with the effort/reward ratio. Most OC were associated with higher levels of job stressors. Some had strong, systematic negative associations with stressors (e.g., highly formatted instructions for the client relationship).

CONCLUSIONS

These findings could help in targeting job stressor prevention and health improvement strategies in CCs.

Health services for women in outpatient substance abuse treatment

OBJECTIVE

To evaluate how a sample of outpatient substance abuse treatment units respond to organizational and environmental influences by adopting and implementing treatment services for women.

DATA SOURCES

The National Drug Abuse Treatment System Survey from 1995 and 2000, a national survey of outpatient substance abuse treatment units.

STUDY DESIGN

Health services for women are the dependent variables. The predictors include organizational and environmental factors that represent resource dependence and institutional pressures for the treatment unit. Logistic regression and Heckman selection models were used to test hypotheses.

DATA COLLECTION

Program directors and clinical supervisors at each treatment unit were interviewed by telephone in 1995 and 2000.

PRINCIPAL FINDINGS

Units that depended on specific funding for women's programs and that depended on government funds were more likely to adopt, but not necessarily implement, women's services. Methadone units and units that train more staff to work with women were more likely to adopt as well as implement women's services. Private not-for-profit units were more likely to adopt some services, while for-profit units were less so. However, in general, neither for-profit nor not-for-profit units significantly implemented services. There was evidence that the odds of adopting services were greater in 2000 than 1995 for two services, but were otherwise stable.

CONCLUSIONS

There is considerable variation in the adoption and implementation of women's services. In addition, not all adopted services were significantly implemented, which could reflect limited organizational resources and/or conflicting expectations. This also suggests that referral mechanisms to these services, and therefore access, may not be adequate. Government funds and specific funds for women's programs are important resources for the provision of these services. Women's services appear more available in methadone units, suggesting that regulation has been influential and that the recent methadone accreditation system should be evaluated. Staff training may be one strategy to encourage implementation of these services. For the most part, the adoption of services for women did not change between 1995 and 2000.