Work characteristics, job satisfaction and intention to leave: a cross-sectional survey of advanced nurse practitioners.

BACKGROUND: Advanced Nurse Practitioners (ANPs) are highly skilled health care professionals with the potential to play a major role in improving the quality and accessibility of health care services. However, there is emerging evidence of disquiet among nurse practitioners who often work in suboptimal work environments. Therefore, it is important to understand the elements that contribute to ANPs' job satisfaction and retention in healthcare services. AIM: To examine the effects of commitment to the workplace, work engagement, and influence at work on job satisfaction and intention to leave of ANPs. METHODS: A total of 153 ANP's on the advanced practice section of the Nursing and Midwifery Board of Ireland register completed a web survey between July and August 2020. Independent variables (commitment to the workplace, work engagement, and influence at work) were measured using the Copenhagen Psychosocial Questionnaire (COPSOQ). Multivariable logistic regression models were used to investigate the association between dependent and independent variables. RESULTS: Participants who reported higher levels of influence at work and higher levels of commitment to the workplace were also satisfied in their job (OR 1.05, 95% CI 1.01-1.09, p = 0.025), (OR 1.10, 95% CI 1.06-1.14, p < 0.001) respectively. Additionally, ANPs with higher levels of commitment to work were significantly less likely to leave their role (OR 0.94, 95% CI .92-.96, p < 0.001). CONCLUSION: Healthcare organisations can improve job satisfaction and decrease intention to leave by creating environments in which ANPs are supported by their colleagues and supervisors, and facilitate their practice to the full extent of their capabilities.

Healthcare professionals' knowledge and attitudes towards surgical site infection and surveillance: A quasi-experimental study.

AIM: SSI is one of the most prevalent healthcare-associated infections and is associated with extended hospital stays, increased need for reoperation and higher hospital readmission rates. Implementing systematic SSI surveillance can reduce these adverse outcomes. Implementing a surveillance system into a hospital is a complex intervention requiring that staff involved in a patient's perioperative journey have the knowledge of SSI prevention, the data required for surveillance, an understanding of how data informs quality improvement initiatives and their role in surveillance. The aim of this study was to evaluate the impact of a complex intervention on the knowledge and attitudes of healthcare professionals towards surgical site infection (SSI), SSI prevention and surveillance in a university hospital setting. DESIGN: The study used a quasi-experimental pre-test-post-test design. METHOD: The impact of a complex intervention was evaluated by measuring healthcare professionals' (n = 74) knowledge of and attitudes towards SSI and surveillance. Normalisation process theory (NPT) guided the study and the development of the intervention. RESULTS: There was a statistically significant increase in scores on the knowledge of SSI and prevention from pre-intervention to post-test. The knowledge of risk factors scores at post-test was significantly higher than that at pre-intervention. Overall attitudes to SSI prevention and surveillance were good both pre-intervention and post-test but there was a significant change in the attitude of participants. The findings reveal an overall positive impact of the complex intervention on the knowledge and attitude of healthcare professionals relating to SSI, SSI prevention and surveillance; however, the extent of the change varied across items measured.

A cognitive task analysis of final year nursing students' situation awareness in simulated deteriorating patient events: A mixed methods study.

AIM: The aim of this study was to: (1) use cognitive task analysis to describe final year nursing students situation awareness in recognising, responding and escalating care of deteriorating patients in ward settings; and (2) make recommendations for training and practice. DESIGN: A mixed methods cognitive task analysis with a convergent triangulation design. METHOD: Data collection involved observations of 33 final year nursing students in simulated deteriorating patient scenarios and retrospective cognitive interviews. A process tracing technique was applied to identify the cues to deterioration participants perceived; how cue perception altered as situational demands increased; the extent that participants made connections between perceived cues and reached a situational understanding; and the factors that influenced and constrained participants situation awareness. Qualitative and quantitative findings are woven together and presented using descriptive statistics, illustrative quotations and timeline extractions. RESULTS: The median cue perception was 65.4% and 57.6% in the medical and surgical scenarios, respectively. Perception was negatively influenced by incomplete vital sign monitoring as situations escalated; limited physical assessments; passive scanning behaviours; poor task automaticity; and excessive cognitive demands. Incomplete perception, poor cue integration and underdeveloped mental models influenced situational understanding. Escalation calls did not always accurately reflect situations and a reporting mindset was evident. Clinical exposure to deteriorating patients was described as variable and opportunistic. REPORTING METHOD: The study is reported in accordance with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist. PATIENT OR PUBLIC CONTRIBUTION: Patients and public were not involved in this research.

People with dementia and family carers are welcoming of a model of dementia palliative care, but sceptical of its implementation.

INTRODUCTION: A palliative care approach can improve quality-of-life for people with dementia. It is the preference of many people with dementia to remain living at home until death, with the appropriate care. To develop a successful model for dementia palliative care in the community, it is essential to assimilate the perspectives and experiences of those affected. The guiding research question for this study was: What are people with dementia and family carers' views on a model for dementia palliative care?. METHODS: Focus groups (n = 3) were conducted with bereaved or current family carers (n = 11), and people with dementia (n = 2). Discussions centred around a proposed model of dementia palliative care. These were transcribed and analysed using thematic analysis. RESULTS: Three main themes were identified: living and dying well with dementia; reducing carer burden to fulfil the wish for home care; and lack of faith in the healthcare system. One statement which summarised the analysis was: "Dementia palliative care is a dream, but not a reality." This reflected participants' repeated "wish" for this "ideal" model of care, but simultaneous scepticism regarding its implementation, based on their prior experiences of healthcare services. CONCLUSION: All participants were welcoming of the proposed model for dementia palliative care and were generally positive about palliative care as a concept relating to dementia. There was consensus that the model would allow people to live and die well with dementia, and reducing the carer burden would fulfil the wish to remain at home. However systemic changes in the healthcare system will be needed to facilitate a truly person-centred, holistic, individualised and flexible model of care.

The association between nurse staffing and quality of care in emergency departments: A systematic review.

BACKGROUND: The relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak. METHODS: We searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach. RESULTS: We identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department. CONCLUSION: Overall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coupled with research that considers the relationship with skill-mix, other staffing grades and patient outcomes as well as a wider range of geographical settings. TWEETABLE ABSTRACT: Lower levels of nurse staffing in emergency departments are associated with delays in patients receiving treatments and poor quality care including an increase in leaving without being seen, delay in accessing treatments and medications and cardiac arrest.

Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries.

OBJECTIVES: To determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety. DESIGN: Baseline cross-sectional survey of 2187 physicians and 6643 nurses practicing in 64 hospitals in six European countries participating in the EU-funded Magnet4Europe intervention to improve clinicians' well-being. SETTING: Acute general hospitals with 150 or more beds in six European countries: Belgium, England, Germany, Ireland, Sweden and Norway. PARTICIPANTS: Physicians and nurses with direct patient contact working in adult medical and surgical inpatient units, including intensive care and emergency departments. MAIN OUTCOME MEASURES: Burnout, job dissatisfaction, physical and mental health, intent to leave job, quality of care and patient safety and interventions clinicians believe would improve their well-being. RESULTS: Poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised. CONCLUSIONS: Burnout, mental health morbidities, job dissatisfaction and concerns about patient safety and care quality are prevalent among European hospital physicians and nurses. Interventions to improve hospital work environments and staffing are more important to clinicians than mental health interventions to improve personal resilience.

'Ageing well': Discursive constructions of ageing and health in the public reach of a national longitudinal study on ageing.

Established in 2006, the Irish Longitudinal Study on Ageing (TILDA) investigates the health, economic and social circumstances of a nationally-representative sample of people aged fifty years and older in a series of biennial data collection waves. Irish newspapers have been reporting the results of TILDA for over a decade and a half, and their texts represent reports of scientific research distilled through the pen of journalists. In their totality, their texts constitute a public discourse on ageing and health. Using critical discourse analysis, we examined the discourse within the texts of a purposive sample of two national daily newspapers. As sites of public discourse, newspapers reflect social life and are influential in forming and legitimating public attitudes. Like other sites of discourse, their language-in-use is contextually located, is rarely neutral and may employ strategies to discursively construct, sustain and privilege particular social identities, including ageing identities. Discursively constructed as 'ageing well', our analysis of newspaper texts revealed a discernible meta-discourse on ageing and health in which ageing was framed as a life course stage that may be cultivated, diligently self-nurtured and exploited for its positive aspects. When considered in light of literature on health and social inequalities, the consequences of this broadly positive ageing discourse can, somewhat perversely, frame older adults in unintended negative ways, including homogenising them and attributing to them capacities for ageing well that they may not possess. Discursively constructing older adults as a social and economic resource can also impose unrealistic expectations on them and may legitimise exploitation and demonstrate how normative ideologies of ageism and ableism are conveyed through legitimising language. Despite these potentially unintended consequences, the available media resources associated with TILDA may represent one of the most important contributions of the study, in terms of informing positive public attitudes towards ageing.