Healthcare professionals' work engagement in Finnish university hospitals.

BACKGROUND: Concerns about the sufficiency and dedication of the healthcare workforce have arisen as the baby boomer generation is retiring and the generation Y might have different working environment demands. AIMS AND OBJECTIVE: To describe the association between work engagement of healthcare professionals' and its background factors at five Finnish university hospitals. METHODS: Survey data were collected from nurses, physicians and administrative staff (n = 561) at all five university hospitals in Finland. Data were collected using an electronic questionnaire that comprised the Utrecht Work Engagement Scale (9 items) and 13 questions regarding the respondents' backgrounds. Descriptive and correlational analyses were used to examine the data. RESULTS: Most respondents were female (85%) and nursing staff (72%). Baby boomers (49%) were the largest generational cohort. The work engagement composite mean for the total sample was 5.0, indicating high work engagement. Significant differences in work engagement existed only among sex and age groups. The highest work engagement scores were among administrative staff. CONCLUSIONS: Work engagement among healthcare professionals in Finnish university hospitals is high. High work engagement might be explained by suitable job resources and challenges, as well as opportunities provided by a frontline care environment. Attention should especially be paid to meeting the needs of young people entering the workforce to strengthen their dedication and absorption.

Two models of nursing practice: a comparative study of motivational characteristics, work satisfaction and stress.

AIM: To examine the differences in work-related motivational and stress factors between two nursing allocation models (the primary nursing model and the individual patient allocation model). BACKGROUND: A number of nursing allocation models are applied in hospital settings, but little is known about the potential associations between various models and work-related psychosocial profiles in nurses. METHOD: A cross-sectional study using an electronic questionnaire. The data were collected from nurses (n = 643) working in 22 wards. In total, 317 questionnaires were returned (response rate 49.3%). RESULTS: There were no significant differences in motivational characteristics between the different models. The nurses working according to the individual patient allocation model were more satisfied with their supervisors. The work itself and turnover caused more stress to the nurses working in the primary nursing model, whereas patient-related stress was higher in the individual patient allocation model. CONCLUSION: No consistent evidence to support the use of either of these models over the other was found. Both these models have positive and negative features and more comparative research is required on various nursing practice models from different points of view. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing directors and ward managers should be aware of the positive and negative features of the various nursing models.

Database nurse staffing indicators: explaining risks of staff job dissatisfaction in outpatient care.

AIM: To explore factors associated with nursing intensity, work environment intensity and nursing resources that may affect nurse job satisfaction and risk of dissatisfaction in outpatient care at one university hospital in Finland. BACKGROUND: Much research has been done to study how nursing intensity, work environment intensity and nursing resources are associated with nurse job satisfaction, but not in the context of outpatient care. METHODS: This research used a cross-sectional design. The data were collected from the hospital information systems of outpatient units (n = 12) in autumn 2010. RESULTS: Management style showed a statistically significant association with job satisfaction. The risk of dissatisfaction increased when nursing staff had no influence over the design of their jobs, when conflicts and contradictions were not addressed in the workplace and when feedback was not processed. CONCLUSIONS: Nursing intensity and work environment intensity had no effect on nurse job satisfaction. Nursing resources and patient satisfaction, on the other hand, were important to nurses' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: The results indicate that nursing management should involve nursing staff in the development of their jobs and the care delivery model.

The method of nursing support in hospital and patients' and family members' experiences of the effectiveness of the support.

Nurses are an important source of support for patients and family members during hospitalization. It is unclear, however, what kinds of support methods are used in hospitals and how the support affects the patient and family member(s). This study describes methods of nursing support in hospital and adult patients' and their family members' experiences of this support. The data were collected in spring 2009 through essays written by and group interviews with nurses (n = 11) working at a Finnish university hospital. The data from patients (n = 9) and family members (n = 7) were collected in individual and group interviews. The material was interpreted by inductive content analysis. In their interaction with patients and family members, the hospital nurses used the methods of emotional and informational support. Patients' and family members' experiences of the effectiveness of this support were related to the establishment of a care relationship, their future outlook, mental well-being and experiences of getting well. The evidence from this research will be useful in developing methods of nursing support for patients and family members and family-oriented care in hospital.

Effect of social support on changes in quality of life in early breast cancer patients: a longitudinal study.

BACKGROUND: Breast cancer diagnosis as well as diversity of the treatment process deteriorates women's quality of life (QOL). Researchers have examined social support and its relations with QOL overall, but less is known about effects of social support on changes in QOL. AIMS: The aim of this study was to examine social support received from social network and nurses within 6 months and QOL in women with breast cancer. METHODS: Women (N = 164) after breast cancer surgery were quasi-randomized to the intervention (n = 85) and control groups (n = 79). Participants completed two well-known QOL questionnaires, and the questionnaire measuring received social support from network and from nurses both 1 week and 6 months after the breast cancer surgery. Data were analysed using descriptive statistics and nonparametric tests. Logistic regression model with the enter method was employed to identify associations between social support and negative changes in QOL. RESULTS: Affect and aid from network decreased in both groups and affirmation in the intervention group within 6 months. No significant changes in received social support from nurses were found within groups. Furthermore, no statistically significant difference in the magnitude of changes over time was found between groups. Received social support had an effect on changes in sexual functioning, global QOL and health and functioning. CONCLUSIONS: Received social support decreased in both groups within 6 months. Significant effects of social support on negative changes on QOL were found. Social support tailored to women's individual needs is an essential part of the care in patients with breast cancer. For further research, longitudinal designs for longer period should be established to explore social support and its effects on QOL.

Explaining patient satisfaction with outpatient care using data-based nurse staffing indicators.

OBJECTIVE: This article examines the associations of nursing intensity, work environment intensity, and nursing resources with patient satisfaction with outpatient care in a university hospital in Finland. BACKGROUND: While readily available in hospital information systems, data-based nurse staffing indicators have not been maximized in ambulatory nursing management and leadership. METHODS: Data were analyzed using descriptive and multivariate statistical methods. RESULTS: Patient satisfaction scores reached target levels at all measurements in 42% of the outpatient departments. The risk of low satisfaction scores was higher when patients received no information about their visits or their illness. Patient dissatisfaction increased linearly with the number of repeat visits. CONCLUSIONS: The patients were predominantly satisfied with the outpatient care. Better access to information improved patient satisfaction. Attention should be directed to the content of information in patient repeat visits.

Support for hospital patients and associated factors.

BACKGROUND: During hospitalization patients need support from nursing staff. To improve the delivery of support during hospitalization, it is necessary to know more about how patient background factors and organizational factors are associated with patients` perceived access to support. AIM: This study describes hospital patients' perceived access to emotional and informational support from nursing staff. A further concern is with the associations of patient background factors (e.g. age, education, mode of admission) and various organizational factors (e.g. nurse to bed ratio, skill mix) with support. METHODS: A quantitative research approach was applied. The data were collected from patients (n = 731) at a Finnish university hospital using a specially developed scale. The sample of hospital patients was drawn from the population by stratified random sampling. In addition, data were retrieved from the hospital's electronic database. RESULTS: During their stay in hospital, patients felt they received more emotional than informational support. Outpatients and elective inpatients reported receiving more support than inpatients and emergency patients. Having a named nurse was also positively associated with access to support. Staffing levels showed a positive association with patient access to support. On the other hand, the availability of support deteriorated when the number of emergency inpatients and the unit workload increased. CONCLUSION: Steps are needed to improve the provision of informational support to nursing care patients and to assess the methods of support provision. Patient support can also be improved by adopting the named nurse system. There is a significant association between organizational factors and patient access to support, which warrants further investigation.

The connection between personnel resources with work loading and patient satisfaction on in-patient wards.

AIM: The aim of the study is to describe the connection between the burden of nurses' work experience and patient dissatisfaction using electronic indicators available in databases. BACKGROUND: The hospitals in this study have a lot of information stored in electronic databases, but the data is stored in different databases and there are no straight connections between them. METHODS: This study was retrospective. Inpatient rates, workload statistics, patient classification, patient satisfaction and financial statistics were collected on 39 hospital wards from electronic databases. The data were analysed statistically. RESULTS: The results showed that the higher care intensity index and number of gross treatment days are, the greater was the burden on nurses. The burden was smaller on those wards using a named nurse system. CONCLUSIONS: Nurses' workload varies according to the condition of patients and patient flow. There is a connection between high workload and patient dissatisfaction. Nurse Managers should easily be able to use significant indicators. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management must have tools that are easy to use in every day workload measurement, burden adjustment and personnel planning in the long run. This article presents patient classification and the number of beds used including daily change percentage of wards as instruments for nursing management.

Nurses' work environment and nursing outcomes: a survey study among Finnish university hospital registered nurses.

The aim was to assess the interrelationships between nurses' work environment and nursing outcomes. A cross-sectional survey of 664 registered nurses (RN) on 34 acute care inpatient hospital wards was used to measure nurses' perceptions. Patient data (n = 4045) consisting of a total patient satisfaction indicator were collected simultaneously with the nurse data during year 2005. RN's assessments of staffing adequacy, respect and relationships were the most important factors of work environment having an influence on job-related stress, job satisfaction, patient satisfaction and adverse events to patients and nurses. Some 77% of the RN reported adverse nurse events and 96% reported adverse patient events during a 3 month retrospective period. Ensuring sufficient and suitably qualified nurses' availability in delivering nursing care is an important management issue. Nurses are concerned about the quality of care, and the concerns perceived by nurses can influence their clinical work.

Innovation in healthcare: a systematic review of recent research.

Research on innovations in healthcare organizations published between 1994 and 2004 are here reviewed and summarized. The majority of the 31 identified studies dealt with the adoption of innovations and new practices and were cross-sectional designs applying quantitative methods, or multiple case studies applying qualitative methods. Five pathways for future research are recommended: (a) Multilevel approaches studying innovation simultaneously on individual, group, and organizational levels; (b) a combination of quantitative and qualitative data; (c) use of longitudinal designs (innovation both as the dependent and independent variable); (d) application of experimental designs in interventions; and (e) exploration of innovation generation and structural innovations.

Enhancing nurses' participation in implementing evidence-based practice.

The article gives an overview of a multidimensional project to enhance nurses' participation in implementing evidence-based practice (EBP) in one university hospital in Finland. The project provided an opportunity for many nurses to be an active part of the EBP process. Moreover, it provided an interesting opportunity to increase all nurses' awareness of EBP.

Measuring patient assessments of the quality of outpatient care: a systematic review.

RATIONALE, AIMS AND OBJECTIVES: The aim of the study was to answer three questions: first, what methods have been used to measure patient assessments of the quality of care? Second, how do outpatients rate their care? And third, what needs to be taken into account in measuring patient assessments of the quality of care? METHODS: Systematic review of the literature. Electronic searches were conducted on Medline, CINAHL and the Cochrane Database of Systematic Reviews. To be included, articles were to deal with patients' assessments of health care in ambulatory units for somatic adult patients. They were to have been published between January 2000 and May 2005, written in English, Swedish or Finnish with an English abstract, and the research was to have been conducted in Europe. The search terms used were: ambulatory care, ambulatory care facilities, outpatient, outpatients, patient satisfaction and quality of health care. The articles were screened by two independent reviewers in three phases. RESULTS: Thirty-five articles were included. The quality of care was measured using both quantitative and qualitative methods. Only a few studies relied on the single criterion of patient satisfaction for quality measurements. It is easy to identify common sources of dissatisfaction in different studies. Sources of satisfaction are more closely dependent on the target population, the context and research design. CONCLUSION: Patient satisfaction is widely used as one indicator among others in assessing the quality of outpatient care. However, there is no single, universally accepted method for measuring this.

Patient satisfaction as a positive nursing outcome.

The purpose of this cross-sectional survey was to assess patient satisfaction and analyze its relationship to nurse staffing levels in 34 inpatient wards at 4 Finnish university hospitals. The patients were satisfied with their care in general. However, the proportion of registered nurses (RNs), the patient-to-RN ratio, and the RNs' working years were highly related to patient satisfaction. Eight patients per RN was the cut-off point for patient satisfaction.

Opening communication with cancer patients about sexuality-related issues.

This study describes 215 healthcare professionals' experiences of discussing sexuality-related issues with cancer patients at a university hospital in Finland. The results indicate that staff on the cancer ward regard discussions about sexuality as a part of their job. However, discussions on these issues are uncommon: 98% of the respondents said that they talked about these issues with less than 50% of their patients, and only 35% started these discussions on their own initiative. The most important reason for not raising the issue is lack of training. More intensive education on how to open discussions on sensitive areas such as sexuality is needed.