A facilitator's reflection on the democratizing potential of emancipatory practice development.

Emancipatory practice development (ePD) is a practitioner-led research methodology which enables workplace transformation. Underpinned by the critical paradigm, ePD works through facilitation and workplace learning, with people in their local context on practice issues that are significant to them. Its purpose is to embed safe, person-centred learning cultures which transform individuals and workplaces. In this article, we critically reflect on a year-long ePD study in an acute care hospital ward. We explore the challenges of practice change within systems, building collective strength with frontline collaborations and leadership to sustain new learning cultures. Our work advances practice development dialogue through working closely with the underpinning theories. Our critique analyses how ePD can enact and sustain change within a complex system. We argue that ePD works to strengthen safety cultures by challenging antidemocratic practices through communicative action. By opening communicative spaces, ePD enables staff to collectively deliberate and reach consensus. Their raised awareness supports staff to resist ways of working which conspire against safe patient care. Sustainability of practice change is fostered by the co-operative democracies created within the frontline team and meso level enablement. We conclude that the democratising potential of ePDt generates staff agency at the frontline.

Designing a Workplace-Based Learning Environment for Learning Health Promotion: A Design-Based Research.

Introduction: The healthcare landscape has a growing emphasis on health promotion (HP), which makes HP important in the training of future physicians. This study employed design-based research to develop a clerkship focused on HP and to outline design principles for shaping workplace learning environments to promote HP learning. Methods: We evaluated a nursing-home clerkship designed at Radboud University Medical Center in the Netherlands, and refined it over three rounds. Data collection involved individual and group interviews with students and supervisors, as well as observations during clerkship-related meetings and activities. These interactions also facilitated the exchange of perspectives between participants and generation of new design ideas, fostering co-creation of the clerkship design. Data were analyzed through iterative thematic inquiry to inform new design choices and develop design principles. Results: Evolved clerkship designs included an app for capturing practice experiences to discuss in relation to students' professional roles, loosening the strict assessment structure, and collaborative creation of a practice assignment about 'Positive Health'. We constructed four design principles, including: to question and discuss students' professional identity, provide concrete and meaningful assignments, aim for a peer-learner role for supervisors, and foster co-creation of the workplace learning environment. Discussion: Our design principles support the design of workplace-based learning for HP, a subject that is novel within healthcare practice. We find that co-creation of workplace-based learning, which requires embracing uncertainty, is pivotal in this context, for students, practitioners, and educational institutions.

Focusing on What Matters.

Health care leaders need to measure their workforce and operational performance in a more comprehensive manner to fully understand the interplay of the many variables that influence performance and the employee experience in health systems. Nurse leaders have an opportunity to leverage that understanding to provide the clinical workforce with a measurably improved workplace.

The Nurse as Coach: Building High Performing Teams.

The provision of modern health care in the United States faces significant challenges, as evidenced by multiple national reports of a workforce in distress. In response to these challenges, the practice of coaching emerges as a transformative skill, recommended for individuals in high-stress environments. Coaching in health care focuses on developing nurses and building teams by fostering self-understanding, deploying strengths, improving relational strategies, and gaining moral clarity. It serves as a potent strategy for nurse leaders to navigate the complexities of their systems. This paper explores the practice of coaching as an important mindset and skill. A coaching mindset is characterized by trust, deep listening, curiosity, embracing both/and thinking, discernment over judgment, and fosters an environment where nurses can flourish. It promotes a shift from telling to asking, empowering individuals to contribute innovative ideas and solutions. Additionally, the paper provides guidance for coaching and tools for maintaining a coaching mindset in the face of chronic stress. By fostering a coaching mindset, employing powerful questions, and using tools to sustain emotional integrity, leaders can empower nurses to thrive in complexity, enhance workplace well-being, and contribute to a resilient health care culture.

An Interprofessional Faculty Development Program for Workplace-Based Learning.

Background: Most faculty development programs in health professions education, pivotal in cultivating competent and effective teachers, focus on systematic, planned and formal learning opportunities. A large part of clinical teaching however, encompasses ad-hoc, informal and interprofessional workplace-based learning whereby individuals learn as part of everyday work activities. To fully harness the educational potential embedded in daily healthcare practices, prioritizing interprofessional faculty development for workplace-based learning is crucial. Approach: Utilizing the 'ADDIE' instructional design framework we developed, implemented and evaluated an interprofessional faculty development program for workplace-based learning. This program, encompassing seven formal training sessions each with a different theme and five individual workplace-based assignments, aimed to support clinical teachers in recognizing and optimizing informal learning. Outcomes: The pilot program (n = 10) and first two regular courses (n = 13 each) were evaluated using questionnaires containing Likert scale items and open textboxes for narrative comments. The quality and relevance of the program to the clinical work-place were highly appreciated. Additional valued elements included practical knowledge provided and tools for informal workplace-based teaching, the interprofessional aspect of the program and the workplace-based assignments. Since its development, the program has undergone minor revisions twice and has now become a successful interprofessional workplace-based alternative to existing faculty development programs. Reflection: This faculty development program addresses the specific needs of healthcare professionals teaching in clinical settings. It stands out by prioritizing informal learning, fostering collaboration, and supporting integration of formal training into daily practice, ensuring practical application of learned knowledge and skills. Furthermore, it emphasizes interprofessional teaching and learning, enhancing workplace environments.

Should Healthcare Organizations Promote a Spiritually Healthy Work Environment?

Both personal spirituality/religiosity and perception of a spiritually respectful work climate are inversely related to burnout among nurses. In addition to briefly reviewing the empirical evidence that consistently supports these assertions, this essay offers some practical suggestions for how nurses can promote a spiritually healthy work environment.

Implementing Strengths-Based Nursing and Healthcare Leadership Values to Promote Equitable, Diverse and Inclusive Workplaces: A Guide for Healthcare Leaders.

Inequities in healthcare persist despite equity, diversity and inclusion (EDI) being embedded in the nursing code of ethics (CNA 2017). Strengths-Based Nursing and Healthcare Leadership (SBNH-L) is "a unique, value-driven, embodied approach that guides leaders and managers to create equitable and safe workplace cultures and environments that honour, develop, mobilize and capitalize on the strengths of individuals and their team" (Gottlieb et al. 2021a: 173) that can be used as a framework to promote EDI in the workplace. Herein, we present concrete suggestions for focusing on EDI through an SBNH-L lens in order to improve healthcare environments for practitioners.

Determinants of psychological injury among health and social care workers in community settings: A systematic review.

BACKGROUND: Health and Social Care (HSC) workers face psychological health risks in the workplace. While many studies have described psychological injuries in HSC workers, few have examined the determinants. Previous research has primarily focused on hospitals, lacking systematic reviews of community-based settings. OBJECTIVE: To systematically identify and appraise current evidence on the determinants of psychological injuries among HSC workers in community settings. METHODS: Searches were conducted in three bibliographic databases, supplemented by citation searches. Included studies focused on community-based HSC workers, reporting statistical associations between psychological injury and personal, health, occupational, or organizational factors. Quantitative studies published in English between January 1, 2000 and August 15, 2023 were included. Quality appraisal was undertaken using the JBI critical appraisal checklist. RESULTS: Sixty-six studies were included. Study quality was highly variable, and all studies were cross-sectional. Twenty-three studies linked psychological injury with occupational factors (e.g. low job control, high job demands and low job satisfaction). Thirteen studies observed an association between work environment and psychological injury, and a further eleven between workplace social support and psychological injury. Fewer studies have examined the relationship between psychological injury and personal/individual factors. CONCLUSION: Occupational and organisational factors are significantly associated with psychological health among HSA workers, in community settings. These aspects of job design, work environment and workplace relationships are modifiable, suggesting an opportunity for work design interventions to improve workers' psychological health and reduce the prevalence of psychological injury in this sector.

Disability disclosure as an impression management technique used in the workplace: A grounded theory investigation.

BACKGROUND: In order to overcome obstacles to entry and inclusion in the workplace, individuals with disabilities engage in various impression management strategies to present themselves as the socially acceptable 'ideal employee.' OBJECTIVE: This study expands on previous disclosure research by asking individuals with disabilities to share their experiences of identity management and workplace challenges. METHODS: We leveraged qualitative research techniques to explore the reciprocal impact of workplace treatment and disclosure. RESULTS: Impression management emerged as an especially salient aspect of participants' disclosure decisions, and participants used an array of impression management tactics. Some employees with disabilities described positive experiences; however, we also learned that impression management can present unique challenges that may outweigh potential benefits. CONCLUSION: Our findings affirm that managing the image we project can be remarkably complicated and effortful when having a disability. This paper concludes with implementation recommendations for vocational rehabilitation counselors and human resource practitioners.

Working environment for historically marginalized faculty, administrators, and librarians in pharmacy education.

INTRODUCTION: Promoting diversity among faculty, administrators, and librarians in schools and colleges of pharmacy (SCOP) would be beneficial for the recruitment and retention of students from diverse backgrounds. Graduating such diverse pharmacists could assist in reducing healthcare disparities. Promoting diversity requires a climate that is inclusive of people from all backgrounds. The goal of this study was to examine the working environment of historically marginalized faculty, administrators, and librarians within pharmacy education. METHODS: An electronic survey was administered to all faculty, administrators, and librarians listed in the American Association of Colleges of Pharmacy roster. RESULTS: Responses from 339 participants were analyzed. Twenty-seven percent of these participants either observed or personally experienced misconduct during the previous five years. When action was taken, it resulted in the cessation of the misconduct only 38% of the time. Respondents most frequently identified the following as ways to make it easier to address misconduct: support from supervisors, support from peers, and education on how to address misconduct. CONCLUSIONS: Exclusionary, intimidating, offensive, and/or hostile communication/behaviors towards historically marginalized faculty, administrators, and librarians do exist in SCOP. The academy should work towards promoting diversity, equity, and inclusion in SCOP through education and provide administrative and peer support for reporting and managing professional misconduct.

Association of quality of nursing care with violence load, burnout, and listening climate.

BACKGROUND: Violence against nurses is common. Previous research has recommended further development of the measurement of violence against nurses and integration of the individual and ward-related factors that contribute to violence against hospital nurses. This study was designed to address these issues by investigating the associations between violence, the listening climate of hospital wards, professional burnout, and perceived quality of care. For this purpose, we used a new operationalization of the violence concept. METHODS: We sought nurses to participate in the study through social media which yielded 765 nurses working in various healthcare systems across Israel who volunteered to complete a self-administered online questionnaire. 80% of the sample were hospital nurses, and 84.7% were female. The questionnaire included validated measures of burnout, listening climate, and quality of care. Instead of using the traditional binary measure of exposure to violence to capture the occurrence and comprehensive impact of violence, this study measured the incremental load of violence to which nurses are subjected. RESULTS: There were significant correlations between violence load and perceived quality of care and between constructive and destructive listening climates and quality of care. Violence load contributed 14% to the variance of burnout and 13% to the variance of perceived quality of care. The ward listening climate moderated the relationship between burnout and quality of care. CONCLUSIONS: The results of this study highlight the impact of violence load among nurses and the ward listening climate on the development of burnout and on providing quality care. The findings call upon policymakers to monitor violence load and allocate resources to foster supportive work environments to enhance nurse well-being and improve patient care outcomes.

The relationship between the level of postural stress, Musculoskeletal Disorders, and chronic fatigue: A case study in the dairy industry.

BACKGROUND: Dairy industry workers face numerous ergonomic risk factors in their workplace, including improper posture, manual material handling, and musculoskeletal disorders (MSDs). Fewstudies have been conducted on the correlation of postural stress, MSDs, and chronic fatigue among workers in the dairy industry. OBJECTIVE: This study aimed to investigate the relationship between the level of postural stress, MSDs, and chronic fatigue in a dairy company. METHODS: In this cross-sectional study, 260 male workers were included in the research based on specific inclusion criteria. The Cornell Musculoskeletal Discomfort Questionnaire, Chalder Fatigue Scale, and a researcher-made demographic questionnaire were used to collect data. The posture of workers was evaluated using RULA and REBA software, and the evaluation of the manual lifting of loads was assessed using the WISHA lifting calculator. Finally, the collected data were entered into the SPSS software version 26.0 and analyzed. RESULTS: The findings revealed a significant statistical relationship between the level of postural stress and chronic fatigue and a significant positive correlation between MSDs and chronic fatigue. Furthermore, a statistically significant relationship was observed between MSDs, chronic fatigue, and ergonomics training experience. CONCLUSIONS: The results obtained in this study support the notion that high levels of postural stress and MSDs can produce an increase in chronic fatigue among workers, and lack of ergonomics training for workers can increase both MSDs and chronic fatigue. Therefore, it is necessary to carry out intervention measures in the field of ergonomics management in similar industries through the implementation of ergonomic intervention programs with a focus on proactive and preventive measures and the use of participatory ergonomic programs and educational demands assessment.

Rationing of nursing care and assessment of work safety and a healthy work environment in intensive care units: A cross-sectional, correlational study.

INTRODUCTION: Rationing of nursing care, whichrefers to the aspects of care not delivered by nurses in an intensive care unit (ICU), has implicationsfor patient outcomes and experiences. OBJECTIVES: This study aimed to identify the extent to which nursing care is rationed in intensive care units, as well as asses quality of nursing care, and the level of job satisfaction and its correlation with an assessment of the climate of work safety, teamwork, and a healthy work environment. METHODOLOGY: A cross-sectional, correlational study was conducted. The study included 226 ICU nurses. It was conducted with the use of three instruments: the Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on the rationing of nursing care, assessment of patient care quality and job satisfaction, American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) and the Safe Attitudes and Behaviours Questionnaire questionnaire in the version: Teamwork and Safety Climate (BePoZa). SETTINGS: Intensive Care Units in Warmia and Mazury Region in Poland. MAIN OUTCOME MEASURES: Level of Nursing Care Rationing in Intensive Care Units. RESULTS: The majority of participants were women (89.82 %) with a mean age of 42.47 years. The average score for nursing care rationing across all groups was 0.58. The mean score for the HWEAT was 2.7 and BePoZa was 3.72. The scores from the questionnaires were negatively correlated with the nursing care rationing scores, being -0.36 for the HWEAT and -0.45 for BePoZa. All correlation coefficients were statistically significant at a p-value of less than 0.05. CONCLUSIONS: It is important to monitor work safety, teamwork climate, and standards of a healthy work environment in ICUs to minimise the risk of rationing nursing care. IMPLICATIONS FOR CLINICAL PRACTICE: Interventions that enhance work organisation and teamwork can elevate nursing quality and job satisfaction in ICUs, while underestimating patient care tasks; thus, highlighting the need for further research on the factors influencing nursing performance.

Meaningful inclusion of people living with HIV as a model for workplace policies: Key findings from the project PEER study.

BACKGROUND: As a large number of people live with HIV, it is worthwhile to examine the integration of this group in the workplace. OBJECTIVE: To investigate how the operationalization of GIPA/MEPA supports workplace policies and practices for PLHIV. The study aims to explore what is being offered to support PLHIV in community-based agencies and what can be done to enhance the offerings. METHODS: For this community-based research, 2 bilingual online surveys were sent to 150 Canadian organizations that work closely with PLHIV or offer support to them. One of the surveys was for Executive Directors of these organizations while the other was sent to peers; i.e. PLHIV whose job is to offer services to PLHIV. Questions in the surveys varied between open-ended, binary, and Likert. RESULTS: GIPA/MEPA are implemented in most organizations and Executive Directors affirmed that PLHIV and their impacts on the workplace are valued. There is a consensus among Executive Directors that formal support is provided but most respondents argued that this support is not specific for PLHIV. More than half of respondents were either unaware or uncertain about the existence of informal support. Peer-employees claimed that one of the challenges of disclosing HIV to receive peer support is that they may face stigma. CONCLUSION: The application of GIPA/MEPA results in positive outcomes in the workplace. The study emphasizes the need to facilitate access to informal support.

Speech-language pathologists' professional stress level and factors affecting it in the Republic of Serbia.

BACKGROUND: In the Republic of Serbia, to our knowledge, there has been no research dedicated to the professional stress faced by speech-language pathologists (SLPs). Since speech therapy belongs to the helping professions, SLPs might experience professional stress. OBJECTIVE: To examine the levels of professional stress in SLPs concerning sociodemographic characteristics and terms of the workplace. METHODS: The research was conducted online, using a questionnaire designed to determine professional stress in speech-language pathologists - Speech-Language Pathologist Stress Inventory. The voluntary sample consisted of 185 employed SLPs from the Republic of Serbia. The stress level was observed concerning marital status, years of working experience, age, educational degree, caseload size, job sector, job setting, type of patients' diagnosis, and type of service which SLPs provide. RESULTS: The results showed that SLPs experience mild to moderate levels of professional stress and that there is a statistically significant difference in the stress level concerning years of working experience, age, job sector, and job setting. Applying Generalized Linear Mixed Model revealed that two-way interaction (Years of working experience * Marital status) and three-way interaction (Age * Job Setting * Type of patients' diagnosis) dominated on the model. CONCLUSION: Since it is noted that SLPs are experiencing mild to moderate levels of professional stress, it is important to emphasize the need for adaptation of existing work terms as well as to provide additional support to speech therapists in order to improve their mental health.

Evaluation of orderliness of underground workplace system based on occupational ergonomics: A case study in Guangzhou and Chengdu metro depots.

BACKGROUND: An underground workplace (UGW) is a complex system with multiple subsystems that interact with each other. However, the research on UGW from a systemic perspective has not received due attention. OBJECTIVE: This study constructs an evaluation approach to the orderliness of UGW and systematically evaluates the UGW with Guangzhou and Chengdu metro depots as case studies. METHODS: First, the evaluation index system is established based on occupational ergonomics. Second, the system entropy model is constructed based on information entropy. Third, a dissipative structure judgment model is built based on the Brusselator. Fourth, the orderliness evaluation model is constructed based on information entropy and synergetics. RESULTS: The UGW of the metro depot has not yet reached the dissipative structure and is in a medium-order state. But the system is in the trend of orderly development. The entropy increase caused by the physical environment and health status is the main obstacle for the system to move toward order. The equipment configuration is an essential source of system negative entropy. The coordination between equipment configuration, health status, and physical environment is low, and that of work effectiveness, equipment aging and failure, and organizational environment is high. CONCLUSIONS: Equipment configuration cannot fully cope with the harsh physical environment and meet the needs of underground workers. Safety security equipment has more room for improvement. Humanized support facilities can introduce more negative entropy to the system. Organizational intervention can reduce the negative impact of adverse factors on the system.

The effect of sleepiness in situation awareness: A scoping review.

BACKGROUND: Situational awareness is the acquisition of information from elements present in the work environment, the perception of the meaning of this information, and the prediction of future working conditions. Sleepiness and fatigue can influence an individual's ability to reach situation awareness, decision-making, and performance on a task. OBJECTIVE: This scoping review examines methods used to assess situational awareness, fatigue, sleepiness, and their interrelationships. METHODS: A systematic search of online databases was conducted to identify experimental, peer-reviewed articles published in English between 2017 and 2022. A total of 29 publications were selected for analysis. RESULTS: The selected studies originated from various countries, primarily in the northern hemisphere. Health and automotive engineering were the academic categories with the highest publications. The studies employed objective and subjective methods to assess situational awareness, fatigue, and sleepiness. CONCLUSIONS: Most studies reported a decline in situational awareness during fatigue and sleepiness conditions, although one study did not find this association. Future research should focus on employing objective methods to analyze cognitive factors, increasing sample sizes, and conducting testing in real-world situations.