Workplace justice and intention to leave the nursing profession.

BACKGROUND:: Poor psychosocial work environments are considered critical factors of nurses' intention to leave their profession. Workplace injustice has been proven to increase the incidence of psychiatric morbidity among workers. However, few studies have directly investigated the effect of workplace justice on nurses' intention to leave their profession and the population attributable risk among nurses. OBJECTIVE:: This study identified factors associated with workplace justice and nurses' intention to leave the profession. METHOD:: A cross-sectional survey was conducted using a self-administered structured questionnaire. Approximately 10% of all secondary referral centers in Taiwan were stratified and randomly sampled. Multiple logistic regression and population attributable risks were preformed to assess the effect of workplace justice on nurses' intention to leave the nursing profession. ETHICAL CONSIDERATIONS:: This study was approved by the Research and Ethical Committee of National Taiwan University Hospital. Only nurses who consented to the study participated in the survey. RESULT:: A total of 2268 nurses were recruited, of whom 1417 (62.5%) satisfactorily completed the questionnaire. The participants were classified and 342 (24.1%) of them were placed into the low workplace justice group. Nurses with low workplace justice had a higher intention of leaving the profession (adjusted odds ratio = 1.34, 95% confidence interval = 1.02-1.77). "Employees' opinions are influential in hospital's decision making" and "employees' performance is evaluated fairly" were the most influential factors of the participants' intention to quit. The adjusted population attributable risk was 3.7% for low workplace justice. CONCLUSION:: This study has identified that workplace justice is a protective factor of nurses' leaving their current profession. A fair performance appraisal system and increased autonomy at work are warranted to dissuade nurses from leaving the nursing profession.

The meaning of rituals after a stillbirth: A qualitative study of mothers with a stillborn baby.

AIMS AND OBJECTIVES: To explore the meaning of rituals that women and their families perform after a stillbirth. BACKGROUND: A cultural taboo in Taiwan prohibits discussing death; thus, parents of stillborn babies have no established public mourning or burial ceremonies to perform for their stillborn children. Stillbirths are often treated as if they had never happened. DESIGN: Qualitative descriptive study. METHODS: In-depth interviews, which were transcribed and content analysed, were conducted with a purposive sample of 16 women discharged from two teaching hospitals in Taiwan after they had a stillbirth. RESULTS: Families engaged in rituals for two underlying reasons: to benefit the deceased child and the immediate family. The meanings of the rituals for the child are presented through three themes: (i) sending the baby's spirit to a safe place, (ii) protecting it from suffering and (iii) preparing it for a better reincarnation. The meanings of rituals for the families are presented through four themes: (i) releasing parental guilt by doing their best for the deceased child, (ii) cutting bonds with the child, (iii) avoiding additional misfortune should they mishandle the funeral and (iv) praying for a successful subsequent pregnancy. CONCLUSIONS: Death-related rituals are highly culturally diverse. This study fills a gap about Asian cultures. Participating in rituals permits a mother to do something for her deceased child, helps relieve her guilt and lets her cope with the stillbirth. Rituals after a stillbirth can help a woman recover from grieving and allow her to hope for a successful subsequent pregnancy. RELEVANCE TO CLINICAL PRACTICE: Health professionals should discuss with bereaved parents what rituals they would like to perform and then respect their decisions. A continuum of care and support that exists from the prenatal diagnosis through the stillbirth and beyond is recommended for parents and families during this difficult time.

A qualitative study of psychosocial factors affecting expecting mothers who choose to continue a cleft lip and/or palate pregnancy to term.

BACKGROUND: Prenatal detection of cleft lip and/or palate (CL/P) leads to high rates of induced termination of pregnancy. There has been little research in Taiwan done on the psychosocial factors affecting those who decide to continue their CL/P pregnancy. PURPOSE: This study identified the principal psychosocial factors that affect expecting mothers who chose to continue their CL/P pregnancy to term. METHODS: Purposive sampling recruited expecting mothers with CL/P-diagnosed fetuses. Recruiting took place between May 2000 and March 2002 at a tertiary referral hospital in Taipei, Taiwan. Those who had decided to continue their pregnancy to term were asked to participate. Researchers obtained oral informed consent to be interviewed during the week following CL/P diagnosis. Interviews for each participant were completed within a 2-week period. All information was given to the interviewees in written and verbal forms before providing their written informed consent to participate. RESULTS: The five major themes central to participant experiences included (1) loss of self-value as a mother, (2) blaming the mother, (3) indecision about whether to continue the pregnancy, (4) anxiety triggered by insufficient information, and (5) burden of care and concerns about potential disadvantaged status. CONCLUSIONS: Significant psychological distress was identified among participants following their fetus' CL/P diagnosis. It was encouraging to learn that all participants told researchers in postpartum interviews that they did not regret the decision to take their child to term.

Assaults against nurses of general and psychiatric hospitals in Taiwan.

PURPOSE: Nurses are at risk of occupational assaults. However, the incidence and effects have not been documented among nurses in Taiwan. We aimed to study the incidence of assaults and their effects, including quality of life and job-related stress among nurses. METHODS: A cross-sectional study was conducted to understand the incidence of work-related assaults in nurses. Job content questionnaire was used to determine the job control, psychological demands at work, and workplace support in these nurses. Quality of life was assessed by short form-36 (SF-36). RESULTS: A total of 842 nurses satisfactorily completed the questionnaire, including 375 from general hospitals and 467 from psychiatric hospitals. A total of 237 (28.1%) reported to have experienced physical and/or verbal assaults in past 6 months. Experiences of sexual assault or verbal abuse were risk factors for feeling threatened by potential attacks. Nurses who felt threatened by potential attacked scored lower in general health, mental health, and vitality by SF-36, and had higher psychological demands at work, lower job control, and lower workplace support. CONCLUSION: We conclude that nurses in general and psychiatric hospitals had high risk of assaults. Worksite assaults caused nurses to feel threatened, and such an effect was likely to cause increased job stress and decreased quality of life.