A quest for quality care: Exploration of a model of leadership relationships, work engagement, and patient outcomes.

AIM: To explore the effects of resonant leadership, leader exchange relationships and perceived organizational support on work engagement and patient outcomes. DESIGN: A cross-sectional survey design. METHODS: Data were collected in June and July 2016 from 252 nurses and clerical staff and institutional patient safety (falls rates) and patient satisfaction (Friends and Family Test) in New Zealand. Data were analysed with structural equation modelling (SEM). RESULTS: The final model was an excellent fit to the data (χ2 (22, N = 252) = 39.048, p = 0.014). Resonant leadership was significantly and positively associated with relationships at work, perception of unit care quality (ß = 0.28, p < 0.001), reduced falls rates (ß = -0.14, p < 0.05) and better patient satisfaction (ß = -0.41, p < 0.001). A direct effect of resonant leadership was demonstrated on patient satisfaction (ß = 0.20, p < 0.01). Perceived organization support (ß = 0.40, p < 0.001) and leader-member exchange (ß = 0.46, p < 0.001) were confirmed antecedents of work engagement. Work engagement was confirmed as an antecedent of nurse perception of unit care quality (ß = 0.21, p < 0.001). Where social exchanges exist, work engagement mediates these. Three further mediated paths bypassed work engagement altogether. CONCLUSION: Existing literature investigating the drivers and impacts of work engagement predominantly focuses on staff outcomes rather than patient outcomes. The findings identify modifiable factors to improve staff experience, patient safety, and ultimately patient satisfaction. Resonant leadership, a relational style, is a core antecedent of quality care and positively associated with staff experience and patient outcomes. IMPACT: This investigation into a real-world problem for nurse leaders also confirmed that an organizational focus on work engagement is not always required. Resonant leadership improves staff work experience, patient safety, and patient satisfaction. Nurse leaders should measure, foster, and develop resonant leadership in practice.

Child protection in the time of COVID-19.

As the number of cases of coronavirus disease 2019 (COVID-19) caused by the virus SARS-CoV-2 rises exponentially in Australia with consequences for the health system and society at large, we need to remember that during this pandemic that necessary social distancing measures, effective school closures and rising unemployment levels may lead to an increased risk for child abuse and neglect.

A paediatric logbook: Millstone or milestone?

Logbooks are ubiquitous in undergraduate and postgraduate medical education. Here, two alumni who are in the early phase of their career, reflect on their experience in their undergraduate paediatric term and how this was shaped by their mandatory paediatric logbook.

Sail sign in neonatal pneumomediastinum: a case report.

BACKGROUND: Pneumomediastinum is an uncommon cause of neonatal respiratory distress. Clinical history and examination of the neonate may be uninformative in determining the aetiology of the respiratory distress. Chest x-ray can be diagnostic of pneumomediastinum however is often difficult to interpret. CASE PRESENTATION: A 36 week gestation newborn was delivered by emergency caesarean section, intubated and given intermittent positive pressure ventilation via Neopuff™ for apnoea before being extubated to CPAP. Chest radiography initially showed bilateral upper zone opacities, presenting a diagnostic dilemma; however subsequent films demonstrated a pneumomediastinum which was managed conservatively and resolved. CONCLUSIONS: The "sail sign" describes an uncommon radiological appearance of a pneumomediastinum in neonates and infants. With careful conservative management, a spontaneous resolution without longterm sequelae can be expected.

Structures and Antimutagenic Effects of Onoceranoid-Type Triterpenoids from the Leaves of Lansium domesticum.

A methanol extract of the dried leaves of Lansium domesticum showed antimutagenic effects against 3-amino-1,4-dimethyl-5 H-pyrido[4,3- b]indole (Trp-P-1) and 2-amino-1-methyl-6-phenylimidazo[4,5- bI]pyridine (PhIP) using the Ames assay. Nine new onoceranoid-type triterpenoids, lansium acids I-IX (1-9), and nine known compounds (10-16) were isolated from the extract. The structures of the new compounds were elucidated on the basis of chemical and spectroscopic evidence. The absolute stereostructures of the new compounds were determined via their electronic circular dichroism spectra. Several isolated onoceranoid-type triterpeneoids showed antimutagenic effects in an in vitro Ames assay. Moreover, oral intake of a major constituent, lansionic acid (10), showed antimutagenic effects against PhIP in an in vivo micronucleus test.

The epidemiology of tuberculosis in children in Australia, 2003-2012.

OBJECTIVE: To describe the burden of and trends in paediatric tuberculosis (TB) in Australia between 2003 and 2012. DESIGN: A retrospective analysis of TB data from the National Notifiable Diseases Surveillance System (NNDSS) on TB in children (under 15 years of age) during the 10-year period, 2003-2012. RESULTS: TB notifications in Australia during the study period included 538 children (range, 37-66 cases per year), representing 4.6% of the total TB case load during the period (range, 3.8%-5.8% each year). Place of birth was recorded for 524 patients (97.4%); of these, 230 (43.9%) were born in Australia, 294 (56.1%) overseas. The average annual notification rate was 1.31 (95% CI, 1.20-1.43) cases per 100 000 child population. The rate was higher for overseas-born than for Australian-born children (9.57 [95% CI, 8.51-10.73] v 0.61 [95% CI, 0.53-0.69] cases per 100 000 children. The overall rate was highest among those aged 0-4 years. The annual notification rate was three times higher for Indigenous children than for non-Indigenous Australian-born children. Of 427 patients (79.4% of total) for whom the method of case detection was recorded, 37.0% were detected by contact screening, 8.7% by post-arrival immigration screening, and 54.3% by passive case detection. Pulmonary TB was the most common diagnostic classification (64.7% of patients). The most common risk factors were close contact with a TB case and recent residence in a country with a high incidence of TB. Treatment outcomes were satisfactory; 89.4% of children had completed treatment or were cured. CONCLUSIONS: The burden of paediatric TB in Australia is low but has not changed over the past decade. The highest rates are among children born overseas, emphasising the important role of immigration screening as Australia aspires to eliminate TB.

Nurses' supervisors, learning options and organisational commitment: Australia, Brazil and England.

AIM: To examine the relationships between leader-member exchange (LMX), workplace learning options (teamwork, training and development), empowerment and organisational commitment, for nurses in Australia, England and Brazil. BACKGROUND: The supervisor-employee relationship is fundamental to management theory and practice within the work context of Organisation for Economic Cooperation and Development (OECD) countries. METHODS: Survey-based, self-report data were collected from 1350 nurses in 23 acute-care hospitals during 2011. RESULTS: Significant relationships were found between key Social Exchange Theory antecedents (LMX and teamwork) and outcomes (organisational commitment) for nurses in Australia and England, but not in Brazil. As expected, the path between teamwork and organisational commitment was significant in the three countries. CONCLUSIONS: The findings affirm the importance of LMX as a management tool affecting employee outcomes in OECD countries. In contrast, LMX cannot be assumed to play an important role within a context that operates a dual employment structure coupled with a culture accepting of 'Jeitinho' workplace relationships. IMPLICATIONS FOR NURSING MANAGEMENT: Informal workplace relationships - 'Jeitinho' (similar to the Chinese 'guanxi') may be worthy of examination within BRICS (Brazil, Russia, India, China and South Africa) countries such as Brazil.

The role of support antecedents in nurses' intentions to quit: the case of Australia.

AIMS: The study used Social Exchange Theory as a lens to examine associations between nurses' support antecedents (supervisor-nurse relationships and perceived organizational support) and their job attitudes (job satisfaction, organizational commitment and engagement). BACKGROUND: Similar to many other westernized countries, there is a shortage of nurses working as nurses in Australia. The attrition of nurses from the workplace continues to be a challenge for many countries, with resultant calls for improved retention rates. DESIGN: The design employed in this study was a Survey. METHODS: A self-report survey of 1600 nurses employed in five private sector hospitals throughout Australia was completed during 2010-2011, resulting in 510 completed surveys. RESULTS: A mediation path model was developed to test the hypotheses and results of Partial Least Squares analysis showed that both support antecedents (supervisor-nurse relationships and perceived organizational support) positively led to engagement and job satisfaction. Subsequently, nurses more satisfied with their jobs were also more committed to their organizations, ultimately leading to lower intentions to quit. In addition, job satisfaction was found to mediate the relationships between organizational commitment and turnover intentions, plus between supervisor-subordinate relationships and turnover intentions. CONCLUSION: In the context of a shortage of nurses and higher than average turnover rates, the findings suggest that it is important to improve nurses' job satisfaction and organizational commitment to improve retention. However, the findings also suggest that workplace relationships and organizational management are currently far from ideal.

Flexibility in change practices and job outcomes for nurses: exploring the role of subjective fit.

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

Organisational change stressors and nursing job satisfaction: the mediating effect of coping strategies.

AIM: To examine the mediating effect of coping strategies on the consequences of nursing and non-nursing (administrative) stressors on the job satisfaction of nurses during change management. BACKGROUND: Organisational change can result in an increase in nursing and non-nursing-related stressors, which can have a negative impact on the job satisfaction of nurses employed in health-care organisations. METHOD: Matched data were collected in 2009 via an online survey at two time-points (six months apart). RESULTS: Partial least squares path analysis revealed a significant causal relationship between Time 1 administrative and role stressors and an increase in nursing-specific stressors in Time 2. A significant relationship was also identified between job-specific nursing stressors and the adoption of effective coping strategies to deal with increased levels of change-induced stress and strain and the likelihood of reporting higher levels of job satisfaction in Time 2. CONCLUSIONS: The effectiveness of coping strategies is critical in helping nurses to deal with the negative consequences of organisational change. IMPLICATIONS FOR NURSING MANAGEMENT: This study shows that there is a causal relationship between change, non-nursing stressors and job satisfaction. Senior management should implement strategies aimed at reducing nursing and non-nursing stress during change in order to enhance the job satisfaction of nurses.

Passionate and psychologically-undetached: A moderated-mediated investigation of psychological distress among engaged employees.

Guided by the effort-recovery model and the dualistic model of passion, we tested a conditional process model that examined the relationships between work engagement, workplace passion, psychological detachment, and psychological distress among Japanese professionals. We conducted an online panel survey across two time points, six weeks apart (N = 202 matched responses) where we measured all the variables at both instances. Findings show that engaged employees become susceptible to psychological distress due to decreased levels of psychological detachment. The moderating role of work passion was partially supported: being obsessively passionate towards work exacerbates this relationship further while contrary to expectations, the moderating role of harmonious passion was not significant. Findings suggest the possibility that engaged employees are less likely to switch off, which predisposes them to ill-being at work, and this becomes apparent among employees with less volitional opportunities in the workplace.

Administrative stressors and nursing job outcomes in Australian public and non-profit health care organisations.

AIMS AND OBJECTIVES: The main aim of this study is to develop a path model to examine the effect of administrative stressors on nursing work outcomes in a sample of Australian public and non-profit nurses. BACKGROUND: The implementation of managerial reform initiatives has negative consequences on work outcomes. However, less is known about the effects of these stressors in public and non-profit health care organisations. DESIGN: An online, self-completion questionnaire was sent to a random sample of nurses, employed in nursing-related occupations. PARTICIPANTS: Useable surveys were received from 251 nurses. METHODS: The path model was analysed using SmartPLS software (SmartPLS, Hamburg, Germany). RESULTS: Public and non-profit nurses experienced time and resource administrative-related stressors (such as resource shortage and pay not as good as other people doing similar work). They relied on work-related social support to reduce the negative consequences. Resource stressors led to job dissatisfaction while time stressors led to psychological strain. Nursing staff who reported better psychological health reported higher job satisfaction and higher level of commitment towards their organisations. CONCLUSIONS: Context-specific administrative stressors have a negative impact on the work outcomes of public and non-profit nurses. Work-related social support mechanisms were found to mediate the negative consequences of administrative resourcing stressors on nursing job satisfaction. RELEVANCE TO CLINICAL PRACTICE: Nursing managers have to be sympathetic and care for the negative experiences of nursing staff, especially when there is an increasing level of administrative expectations during organisational change. Senior management should take note of the stressors caused by the lack of resources such as information, staffing and resources, as these were found to lead to an increase in nurses seeking work-related social support from their peers and supervisors. Effective implementation of these strategies would lead to a nursing workforce, which has higher level of psychological health, job satisfaction and organisational commitment.

Documentation of paediatric head injuries in a mixed metropolitan emergency department.

OBJECTIVE: Head injuries are a common presentation of children to Australian EDs. Healthcare documentation is an important tool for enhancing patient care. In our study, we aimed to assess the adequacy of paediatric head injury documentation in a mixed ED. METHODS: A retrospective analysis of presentations to a mixed ED between 2017 and 2018. Children aged <16 years old with a primary diagnosis of head injury were included. Documentation items based on local head injury guidelines were assessed in both medical and nursing documentation. We compared cases aged <1 and ≥1 year. RESULTS: There were 427 presentations that met the case definition. Medical documentation was present in 422 cases and nursing documentation in 310 cases. In combined medical and nursing documentation, items poorly documented include blood pressure (BP; 21.3%) and secondary survey (16.9%). In solely medical documentation, least commonly documented items are high-risk bony injuries (22.5%), high-risk soft tissue injuries (22.3%), seizure (22.0%) and non-accidental injury (3.6%). Glasgow Coma Scale (GCS) was poorly documented in cases aged <1 year (10.9%, P < 0.001). CONCLUSIONS: The largest gaps in the documentation of paediatric head injuries were BP and paediatric GCS in infants. Future audits and educational strategies should focus on targeting clinically relevant items that are predictive of serious outcomes.

Development and Validation of the Holistic Cognition Scale.

This paper introduces a new scale to measure cognitive cultural differences, drawing on the theory of analytic versus holistic thought. Examining culture from a cognitive perspective is a challenge to traditional values-based approaches. Existing measures based on this framework are methodologically problematic and warrant renewal. This paper presents development and validation studies for a new instrument that measures analytic versus holistic cognitive tendencies at the individual level. The scale assesses four previously established dimensions: attention, causality, contradiction, and change. The present work follows well-established scale development protocols and the results show that the 16-item Holistic Cognition Scale (HCS) is a valid and reliable measure of analytic versus holistic thought. Three new studies with four unique samples (N = 41; 272; 454; and 454) provide evidence to support the content validity, reliability, and factor structure of the new instrument, as well as its convergent, discriminant, and concurrent validity against comparable constructs. Convergent validity is established against measures of compromise, intuition, complexity, and collectivism; predictive validity is established against Hofstede's (1980) five cultural value dimensions; and discriminant validity is established using the average variance extracted from a confirmatory factor analysis. The new HCS is an improvement over previous attempts with a balanced number of forward- and reverse-scored items, superior reliability, less redundancy, and stronger factor loadings.

Workplace bullying, psychological hardiness, and accidents and injuries in nursing: A moderated mediation model.

Workplace bullying are prevalent among the nursing workforce. Consequences of workplace bullying include psychological stress and workplace accidents and injuries. Psychological hardiness is proposed as a buffer for workplace bullying and psychological stress on workplace accidents and injuries. This study adopted the Affective Events Theory and Conservation of Resources Theory to develop and test a moderated mediated model in two field studies. Study 1 (N = 286, Australian nurses) found support for the direct negative effect of workplace bullying on workplace accidents and injuries with psychological stress acting as the mediator. The mediation findings from Study 1 were replicated in Study 2 (N = 201, New Zealand nurses). In addition, Study 2 supplemented Study 1 by providing empirical support for using psychological hardiness as the buffer for the association between psychological stress and workplace accidents and injuries. This study offers theoretical and empirical insights into the research and practice on psychological hardiness for improving the psychological well-being of employees who faced workplace mistreatments.

Factors predictive for computed tomography use and abnormality in paediatric head injuries in Australia and New Zealand.

OBJECTIVES: To investigate patient-level factors predictive for computed tomography of the brain (CTB) use and abnormality in head injured children in Australia and New Zealand. METHODS: Retrospective data from tertiary, urban/suburban and regional/rural EDs including factors predictive for CTB use and abnormality. RESULTS: Of 3072 children at 31 EDs, 212 (6.9%) had a CTB scan, of which 66 (31%) were abnormal. Increasing age, serious mechanisms of injury and decreasing Glasgow Coma Score were predictive for ordering CTB. Decreasing age was predictive for CTB abnormalities. Other factors were not. CONCLUSION: Patient-level drivers of CTB use in children in Australia and New Zealand are consistent with international data.