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Planned changes to nurse leadership, staffing and skill-mix: Impact on the working environment, job satisfaction and intention to leave
Get PDFIntroduction: Job satisfaction and intention to leave have been consistently linked to the working environment. However, there are few studies of interventions for improving the environment or staff outcomes. Aim: To determine the impact of implementing a framework for safe nurse staffing on the environment and staff outcomes. This involved an assessment of required nursing hours per patient day, supernumerary nurse in charge and minimum 80:20 skill-mix, with intentional changes in staffing if required. Design: A pre-post observational design. Methods: This was a prospective observational study in six medical and/or surgical wards across three acute hospitals in Ireland. The outcomes were measured pre- and post-implementation, and included the environment, using the Practice Environment Scale of the Nursing Work Index; and job satisfaction and intention to leave using a dichotomised 4-point scale. Outcomes: Changes in staffing levels, adjustments to skill-mix and the supervisory role of the ward leader were seen following the implementation. A multilevel model found significant increases over time on three of the five Nursing Work Index subscales: Staffing and Resource Adequacy, Collegial Nurse-Physician Relations, and Nurse Participation in Hospital Affairs. Job satisfaction increased and intention to leave decreased, although the differences were not statistically significant. Increased job satisfaction was significantly associated with Staffing and Resource Adequacy, Collegial Nurse Physician Relations and Nurse Manager, Leadership and Support. A decreased odds of intention to leave was associated with increased job satisfaction. Conclusion: There were significant improvements in the environment following the implementation of the Framework. Three of the practice environment subscales were significantly associated with job satisfaction, while job satisfaction is a predictor of intention to stay. This study indicates that intentional changes to staffing can result in improvements to working environments which may in turn have an impact on job satisfaction and furthermore, on intention to stay. Impact: This study investigated intentional changes to nurse staffing in medical and surgical wards, examining the impact pre- and post-implementation. This study underlined that when staffing is based on a systematic approach, based on a Framework for Safe Nurse Staffing, a subsequent improvement can be seen in staff\u27s perceptions of the work environment, along with improvements in staff outcomes. This research will impact on staff working in acute settings as a means of determining staffing and improving outcomes using a Framework for Safe Nurse Staffing. Reporting Method: STROBE checklist. Patient or Public Contribution: No patient or public contribution
Split nationality households: A strategic response to optimise the citizenship constellations of transnational families
Get PDFThis paper explores the citizenship choices of Chinese migrants in Australia who must evaluate the relative benefits of Australian versus Chinese legal citizenship. Given the insecurities inherent in non-citizen status in either country, many families decide some members will take Australian citizenship while others retain Chinese citizenship in combination with Australian permanent residency. Forming these split nationality households aims to optimise the benefits and limit risk across all jurisdictions, attempting to exert control over personal circumstances and manage feelings of fear and anxiety in the face of unpredictable national policies and broader geopolitical instability. The paper extends Bauböck\u27s concept of citizenship constellations beyond a consideration of the individual as the unit of analysis to include a more complex network of family memberships. This expanded analysis of how webs of complementary and/or competing rights and obligations act on individuals within their family relations has application beyond these specific and situated cases and can improve our understanding of how migrants interpret the value of local, state, national and supranational memberships in various global contexts
The effect of non-pharmacological interventions on cognitive function in cancer: An overview of systematic reviews
Get PDFPurpose: A significant number of cancer survivors experience cancer-related cognitive impairment (CRCI), which can impact their ability to think, reason, make decisions, and perform daily actions. In recent years, non-pharmacological interventions for CRCI have gained significant attention. These interventions include exercise, cognitive behavioural therapy, cognitive training/remediation, dietary, mind–body, and multi-modal/complex interventions. This umbrella review provides a critical overview to inform guidelines and current practice, identify the most promising interventions, and uncover gaps in the research literature. Methods: This umbrella review of systematic reviews was pre-registered on Open Science Framework and PROSPERO. Six databases were searched. Systematic reviews (SR) assessing any non-pharmacological interventions to improve cognition in cancer (any type) were included. The overview followed gold-standard guidelines and recommendations. The results were narratively synthesised, and descriptive statistics and effect size ranges were calculated. Results: Sixty-four (n = 64) SRs were included. Results were synthesised into four non-pharmacological domains. Cognitive training/rehabilitation had the strongest evidence for efficacy. Physical activity/exercise showed promising efficacy; however, the variability of findings was considerable. Mind–body and psychological/behavioural therapy interventions were limited, but there was evidence for short-term effectiveness. Multi-modal/complex interventions showed potential for improving cognition in cancer but were poorly defined. Conclusions: Overall, non-pharmacological interventions demonstrated efficacy for improving cognition in cancer. There were limited intervention characteristics within domains which were consistently related to efficacy. Three key recommendations are provided for future research: (1) adopt harmonisation and reporting guidelines; (2) develop definitional guidelines of cognitive domains for CRCI research; and (3) assess intervention and participant characteristics associated with positive versus null/negative findings
Web-based application for reducing methamphetamine use among Aboriginal and Torres Strait Islander People: Randomized waitlist controlled trial
Get PDFBackground: Digital interventions can help to overcome barriers to care, including stigma, geographical distance, and a lack of culturally appropriate treatment options. “We Can Do This” is a web-based app that was designed with input from cultural advisors and end users to support Aboriginal and Torres Strait Islander people seeking to stop or reduce their use of methamphetamine and increase psychosocial well-being. Objective: This study aimed to evaluate the effectiveness of the “We Can Do This” web-based app as a psychosocial treatment for Aboriginal and Torres Strait Islander people who use methamphetamine. Methods: The web app was evaluated using a randomized waitlist controlled parallel group trial. Participants were Aboriginal and Torres Strait Islander people aged 16 years or older who self-identified as having used methamphetamine at least weekly for the past 3 months. Participants were randomized on a 1:1 ratio to receive either access to the web-based app for 6 weeks or a waitlist control group. Both groups received access to a website with harm minimization information. The primary outcome was days of methamphetamine use in the past 4 weeks assessed at 1, 2, and 3 months post randomization. Secondary outcomes included severity of methamphetamine dependence (Severity of Dependence Scale [SDS]), psychological distress (Kessler 10 [K10]), help-seeking behavior, and days spent out of role due to methamphetamine use. Results: Participants (N=210) were randomized to receive either access to the web-based app (n=115) or the waitlist control condition (n=95). Follow-up was 63% at 1 month, 57% at 2 months, and 54% at 3 months. There were no significant group differences in days of methamphetamine use in the past 4 weeks at 1 the month (mean difference 0.2 days, 95% CI -1.5 to -2), 2 months (mean difference 0.6 days, 95% CI -1 to 2.4 days) or 3 months (mean difference 1.4 days, 95% CI -0.3 to 3.3 days) follow-up. There were no significant group differences in K10 scores, SDS scores, days out of role, or help-seeking at any of the 3 follow-up timepoints. There was poor adherence to the web-based app, only 20% of participants in the intervention group returned to the web-based app after their initial log-in. Participants cited personal issues and forgetting about the web-based app as the most common reasons for nonadherence. Conclusions: We found poor engagement with this web-based app. The web-based app had no significant effects on methamphetamine use or psychosocial well-being. Poor adherence and low follow-up hindered our ability to accurately evaluate the effectiveness of the web-based app. Future web-based apps for this population need to consider methods to increase participant engagement
Willingness to pay for blue-green space and koala habitat protection following a Covid-19 versus bushfire experimental prime
Get PDFCommunity-supported investment in blue-green space and fauna habitat protection is important, yet the drivers of willingness to pay (WTP) are poorly understood. Moreover, research on WTP for environmental services rarely considers the role of context in determining which services donors prefer. We address these gaps with a novel experimental approach (N = 360), randomly assigning participants to a condition priming either Covid19, the Australian 2019-2020 bushfires, or to one of two control conditions. We measured subsequent WTP for blue-green space and koala habitat, finding mostly non-significant effects for experimental condition on WTP, preparedness to donate, or the importance placed on investment. Both WTP for blue-green space and koala habitat was significantly associated with experience with bushfire, left-leaning political orientation, and higher blue-green space usage. Assessment of WTP for blue-green space in Australian cities indicates a positive attitude, especially among active users, although people are still willing to contribute to koala protection
Silence is not golden: How academic nursing and midwifery is failing our Afghan sisters
No full textAt the end of 2024, international news agencies began reporting that the Taliban government in Afghanistan had banned women from attending institutions providing education and training in nursing and midwifery. There is still no official confirmation of the decision from the Afghan government, but the move is widely reported across a range of reputable sources and is in line with Taliban policy on women’s education and rights more generally
Empowerment through choice: The interplay of choice and control after spinal cord or brain injury
No full textPurpose: To gain knowledge of the early phase post-injury experiences related to choice and control for individuals living with acquired brain injury or spinal cord injury, as well as their caregivers. Materials and Methods: A qualitative study was conducted to understand the experiences of individuals with acquired brain injury or spinal cord injury and their caregivers in the early phase post-injury, focusing on the aspects of choice and control. Nine individuals with acquired brain injury or spinal cord injury and four of their caregivers participated in semi-structured in-depth interviews, and the data was analysed using thematic analysis. Results: Four themes emerged: (1) Passenger in the system, (2) Can’t do it alone, (3) I want to improve, and (4) A new normal. A sense of empowerment or vulnerability may be influenced by participants’ experiences of choice and control. Conclusion: The study offers insights for healthcare professionals aiming to enhance the sense of choice and control for individuals living with acquired brain injury or spinal cord injury. An approach involving shared control and promoting choice, agency, and empowerment may positively influence post-injury experiences for these individuals
Benefits and Challenges with the Modular Model of Teacher Certification in Australia: Listening to Teachers’ Voices
Get PDFThis paper examines teachers’ views about the Highly Accomplished and Lead Teacher (HALT) Certification 2.0 Modular Model (CMM 2.0). The research reveals teachers’ voices and agency in relation to HALT certification. Participants in this study included HALT certified teachers, current HALT participants, and prospective participants. The semi-structured interviews conducted provide insights into the benefits and challenges associated with the CMM 2.0. Thematic coding and systematic analysis were applied to the data to arrive at the key findings. The research revealed that teachers believed that the modular approach was advantageous as it was flexible and provided professional recognition and development. Issues identified by the participants were the time, cost and workload involved, and the role of leadership and peer collaboration in certification. This study makes a contribution to knowledge about the nature and benefits of a modular approach, which can inform the design and implementation of certification in Australia and internationally
Luxury fashion repurchase intentions among Chinese Gen Y: Investigating consumer attitudes and the impact of the COVID-19 pandemic
No full textChina’s leading position in the global luxury market indicates the popularity of luxury items among Chinese consumers. Previous research has extensively examined the motivators of Chinese luxury consumption, emphasising the importance of social and personal motivations, such as social conformity, peer influence, and face consciousness. However, the COVID-19 pandemic, the first global health crisis in nearly a century, severely disrupted consumer behaviour, including luxury consumption. Given that Chinese Gen Y represents the largest demographic group in contemporary China and a dominant market for luxury fashion items, it is crucial to investigate whether the motivations for luxury fashion consumption have shifted in response to the pandemic’s disruptive impact on their consumption patterns. This study’s objectives are to investigate factors influencing the intention to repurchase luxury fashion items among Chinese Gen Y consumers and whether these factors have shifted due to the disruptive impact of the COVID-19 pandemic. A mixed-method approach with a two-stage study was adopted to address the objectives. The study commenced with a quantitative questionnaire to test the proposed theoretical model and examine the interrelations among the constructs through Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM). In the subsequent stage, in-depth qualitative interviews were performed, with the data analysed thematically to further explore the shifts in these factors resulting from the disruptor. Key findings highlight the substantial role of the social and cultural environment in shaping the motivations behind Gen Y’s consumption patterns. The quantitative analysis revealed that face consciousness became a significant factor only after the pandemic’s outbreak, challenging previous studies that anticipated a decrease in its importance. This could be attributed to the qualitative insight that participants experienced a shift in mindset and personality, becoming less concerned with social pressure, thus allowing for more open and honest expression of their real thoughts. Interestingly, while there was a general decline in consumption patterns, a stable or even increased spending was also identified, due to the desire for self-pleasure during challenging times. The pandemic also amplified the emphasis on family well-being, suggesting a resurgence of traditional ideologies where family is consistently regarded as a core value. Furthermore, a growing preference for Chinese indigenous brands was observed, due to their support for regions severely impacted by the pandemic, which fostered a heightened sense of national cultural pride. This study’s findings support previous research outcomes and provide additional insights into the varying impacts on repurchasing luxury fashion items among Chinese Gen Y consumers, particularly given the pandemic’s disruptive impact. These findings highlight the importance of marketers incorporating current societal dynamics when crafting strategies to address changing consumer preferences. Furthermore, this study bridges a gap in existing Chinese luxury consumption literature by examining the interplay of luxury value, personal value, and self-perception, while providing fresh insights into how major disruptors, such as the pandemic, reshape these factors’ impact on the luxury fashion consumption patterns of Chinese Gen Y consumers. Future research directions, including an investigation into the ongoing impact of the pandemic as a major disruptor, are also outlined
Observed and Reported Outcomes Following Experiential Cultural Capability and Clinical Yarning Training for Clinicians Treating Aboriginal and Torres Strait Islander People with Persistent Pain
Get PDFCommunication is recognised as crucial to culturally safe healthcare, and poor communication remains a major reason that Aboriginal and Torres Strait Islander people do not access healthcare. This pragmatic, pre-post comparison study employed mixed methods to evaluate cultural capability and clinical yarning training delivered to 57 clinicians supporting Aboriginal and Torres Strait Islander people at three persistent pain management services in Queensland, Australia. Observable outcomes of the training were evaluated by video recording clinicians’ training experiences and seven consultations with patients that occurred either pre- or post-training. Reported outcomes were evaluated by using a modified Cultural Safety Survey (CSS), which was completed by 67 patients during a period pre- and post-training delivered to the clinicians. Using conversation analysis methods and focusing on clinicians recorded both pre- and post-training, analysis of video recordings identified observable differences in communication practices that were consistent with learning opportunities in the training. Statistical analysis of the CSS survey focused on subsamples of data from 20 patients who consulted clinicians who attended training. A comparison of pre- and post-training data and found no difference in the overall score of the CSS (p=0.594). The study identified differences in social practices following training but did not find changes to patient experiences of care. These findings demonstrate the feasibility of changing clinical communication in relation to culture, while also highlighting the importance of examining practices used in social interaction to determine whether and how training is applied by learners