The effect of bullying on burnout in nurses: the moderating role of psychological detachment.

AIMS: The aim of the study was to examine the relationship between bullying and burnout and the potential buffering effect psychological detachment might have on this relationship. BACKGROUND: There is evidence to suggest that bullying is relatively widespread in the nursing profession, with previous studies indicating that bullying is associated with higher levels of burnout. There is, however, limited research focusing on potential moderators of the relationship between bullying and burnout. DESIGN: A cross-sectional quantitative study conducted with self-completed, anonymous questionnaires. METHODS: The study was conducted in 2011 with 762 Registered Nurses in Australia. Two hypotheses were tested with validated measures of bullying, psychological detachment and burnout. The hypotheses were tested using hierarchical regression. RESULTS: Bullying is positively associated with burnout. Psychological detachment does not significantly moderate the relationship between bullying and burnout. CONCLUSION: The results indicate that bullying exacts a strong negative toll on nurses. Ensuring there are workplace policies and practices in place in healthcare organizations to reduce the instances of bullying and proactively address it when it does occur would therefore seem crucial. Individuals may also lower their risk of burning out by psychologically detaching from work.

Effective design, implementation and management of change in healthcare.

Changes in healthcare organisations are common, and their implementation is often complex and challenging. Change is often implemented suboptimally, and can have several negative effects on staff turnover, patient care and budget targets. To minimise and avoid negative outcomes, a systematic three-stage change process that comprises preparing for change, implementing change, and evaluating and sustaining change can be followed. In the first stage, before commencing any change activities, time and attention should be given to conducting detailed analyses and preparatory work to establish the foundation for the implementation phase. In the second stage, a clear set of multiple implementation tactics are used to ensure the change process is effective. In the final stage, an evaluation of the success of the change is undertaken and measures are put in place to ensure it is sustained over time. It is only by following a methodical change process such as this that changes can be implemented effectively in healthcare organisations.

Understanding bullying in healthcare organisations.

Bullying is a pervasive problem in healthcare organisations. Inquiries and reports on patient care and poor practice in the NHS have emphasised the substantial negative effects this behaviour may have on patient care. If bullying is to be addressed, it is crucial we develop clarity about what behaviours constitute bullying and how these behaviours differ from other negative behaviours in the workplace. It is important that we recognise the extent of the problem; statistics on the prevalence of bullying are likely to be an underestimate because of under-reporting of bullying. Effective interventions may only be designed and implemented if there is knowledge about what precipitates bullying and the magnitude of the changes required in organisations to tackle bullying. Individuals should also be aware of the options that are available to them should they be the target of bullying behaviour and what they should do if they witness bullying in their workplace.

Consumption-based approach for assessing the contribution of hospitals towards the load of pharmaceutical residues in municipal wastewater.

Hospitals are considered as major sources of pharmaceutical residues discharged to municipal wastewater, but recent experimental studies showed that the contribution of hospitals to the loads of selected, quantifiable pharmaceuticals in sewage treatment plant (STP) influents was limited. However such conclusions are made based on the experimental analysis of pharmaceuticals in hospital wastewater which is hindered by a number of factors such as access to suitable sampling sites, difficulties in obtaining representative samples and availability of analytical methods. Therefore, this study explores a refined and extended consumption-based approach to predict the contribution of six selected Australian hospitals to the loads of 589 pharmaceuticals in municipal wastewater. In addition, the possibility that hospital-specific substances are present at levels that may pose a risk for human health was evaluated. For 63 to 84% of the pharmaceuticals investigated, the selected hospitals are not a major point source with individual contributions likely to be less than 15% which is in line with previous experimental studies. In contrast, between 10 and 20% of the pharmaceuticals consumed in the selected hospitals are exclusively used in these hospitals. For these hospital-specific substances, 57 distinct pharmaceuticals may cause concerns for human health as concentrations predicted in hospital effluents are less than 100-fold lower than effect thresholds. However, when concentrations were predicted in the influent of the corresponding STP, only 12 compounds (including the antineoplastic vincristine, the antibiotics tazobactam and piperacillin) remain in concentration close to effect thresholds, but further decrease is expected after removal in STP, dilution in the receiving stream and drinking water treatment. The results of this study suggest that risks of human exposure to the pharmaceuticals exclusively administered in the investigated hospitals are limited and decentralised wastewater treatment at these sites would not have a substantial impact on pharmaceutical loads entering STPs, and finally the environment. Overall, our approach demonstrates a unique opportunity to screen for pharmaceuticals used in hospitals and identifying priority pollutants in hospital wastewater explicitly accounting for site-specific conditions. Being based on consumption and loads discharged by hospitals into municipal wastewater, it is not limited by 1) the big effort to obtain representative samples from sewers, 2) the availability of sensitive chemical analysis or 3) a pre-selection of consumption data (e.g. consumption volume).

The effect of pre-pregnancy counselling for women with pre-gestational diabetes on maternal health status.

OBJECTIVE: To assess the impact of pre-pregnancy counselling (PPC) on the health of diabetic women in early pregnancy as compared to their health at the time of PPC. STUDY DESIGN: Retrospective cohort study involving all the diabetic women who attended PPC and subsequently become pregnant in the decade 1997-2007. The proforma had two sections: one for the PPC visit and one for the booking visit. Details on demographic factors, control and complications of diabetes, folic acid, current medication, weight, contraception, smoking and alcohol consumption were documented. RESULTS: Fifty-seven women who became pregnant after PPC were studied. There was optimisation of diabetic control with a significant reduction in HbA1c levels at booking as compared to PPC (7.5% vs 8.8%, p<0.0001). Diabetic surveillance (retinopathy and nephropathy screening) was up to date at the time of booking in >80% of the cases. Alteration of insulin regimes was undertaken in ∼ 1 in 5 women. Folic acid was taken by most patients (48/54) at booking. There was no significant reduction in the number of women who smoked at booking compared to PPC. CONCLUSION: The effect of PPC was evident in the improvements in the markers of health of diabetic women in early pregnancy compared to at the time of PPC.