1,720,979 research outputs found
Characteristics of shift work and their impact on employee performance and wellbeing: a literature review
No full textBACKGROUND: Shift work is recognised as a component of work organisation that may affect the balance between employee’s efficiency, effectiveness and wellbeing. Shift work is frequent in healthcare and for nurses in particular, as they typically comprise a large proportion of the workforce in healthcare AIM: To identify the characteristics of shift work that have an effect on employee’s performance (including job performance, productivity, safety, quality of care delivered, errors, adverse events and client satisfaction) and wellbeing (including burnout, job satisfaction, absenteeism, intention to leave the job) in all sectors including healthcareMETHODS: A search of electronic databases (CINAHL, MEDLINE, PsychINFO, SCOPUS) to identify primary quantitative studies was conducted between January and March 2015. Studies were drawn from all occupational sectors (i.e. health and non health), meeting the inclusion criteria: involved participants aged ?18 who have been working shifts or serve as control group for others working shifts, exploring the association of characteristics of shift work with at least one of the selected outcomes. Reference lists from retrieved studies were checked to identify any further studiesRESULTS: 35 studies were included in the review; 25 studies were performed in the health sector. A variety of shift work characteristics are associated with compromised employee’s performance and wellbeing. Findings from large multicentre studies highlight that shifts of 12 hours or longer are associated with jeopardised outcomes. Working more than 40 hours per week is associated with adverse events, while no conclusive evidence was found regarding working a ‘Compressed Working Week’; working overtime was associated with decreased job performance. Working rotating shifts was associated with worse job performance outcomes, whilst fixed night shifts appeared to enable resynchronisation. However, job satisfaction of employees working fixed nights was reduced. Timely breaks had a positive impact on employee fatigue and alertness, whilst quick returns between shifts appeared to increase pathologic fatigue. The effect of shift work characteristics on outcomes in the studies reviewed is consistent across occupational sectorsCONCLUSIONS: This review highlighted the complexity that encompasses shift work, but many studies do not account for this complexity. While some consistent associations emerge (e.g. 12 hour shifts and jeopardised outcomes), it is not always possible to conclude that results are not confounded by unmeasured factors <br/
Under the radar: The benefits of a sociological view of nurses’ ‘non-compliance’ in hospital wards at night
No full textThis paper demonstrates how a 'sociology of healthcare safety and quality' (Allen et al., 2015) can expand understanding of staff 'non-compliance'. Following Allen (2016) it uses aspects of Actor-network theory and the concept of working practices to challenge the mainstream Quality Improvement approach of treating staff concerns as 'resistance' to be overcome. This research was part of a study exploring nurses' relative 'non-compliance' with a vital signs observation protocol at night. An Early Warning System (EWS) algorithm prescribed frequency of observations when readings deviated from a 'normal' range. Semi-structured interviews were carried out with 17 nursing staff on wards with differing levels of compliance with the protocol. An electronic device had a delegating (calculating observation intervals) and prescriptive role (informing nurses when to carry out observations). Data was used by hospital management to assess ward compliance with the protocol. Interviewees described how the use of these actants (electronic device, ward compliance targets and protocol) provided some affordances. Yet the measurement of prescribed activity as 'compliant' or 'non-compliant' with no opportunity for nurse input removed nurses' mediating role and reduced their sense of professional autonomy. However nurses' accounts of decisions not to comply suggested certain patient groups might be unintentionally under-monitored at night. It was recommended that nurses' judgements about non-compliance be incorporated into the system to restore nurses' mediating role but also highlight potential risks. This research demonstrates how a sociological approach can address staff concerns and patient safety while making visible the impact of technology on ward decision making
Development of a Decision Aid to support surgical and clinical decision making of young women diagnosed with early stage breast cancer
No full textUsing text mining to facilitate qualitative analysis of patient comments within the colorectal cancer survivorship survey
No full textNurse staffing and patient outcomes: strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence safe staffing guideline development
Full text linkA large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as “compelling” and “overwhelming”, there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence (NICE), which concluded there is insufficient good quality evidence available to fully inform practice. In this paper we explore this apparent contradiction. After summarising the evidence review that informed the NICE guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey. Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a series of questions about design and methods for future researchers who intend to further explore this complex relationship between nurse staffing levels and outcomes. These questions are intended to reflect on the potential added value of new research given what is already known, and to encourage those conducting research to take opportunities to produce research that fills gaps in the existing knowledge for practice. By doing this we hope that future studies can better quantify both the benefits and costs of changes in nurse staffing levels and, therefore, serve as a more useful tool for those delivering services. <br/
Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study.
Full text linkOBJECTIVE: To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality. DESIGN: This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean. Analyses were controlled for ward and patient risk. PARTICIPANTS: 138 133 adult patients spending >1 days on general wards between 1 April 2012 and 31 March 2015. OUTCOMES: In-hospital deaths. RESULTS: Hospital mortality was 4.1%. The hazard of death was increased by 3% for every day a patient experienced RN staffing below ward mean (adjusted HR (aHR) 1.03, 95% CI 1.01 to 1.05). Relative to ward mean, each additional hour of RN care available over the first 5 days of a patient's stay was associated with 3% reduction in the hazard of death (aHR 0.97, 95% CI 0.94 to 1.0). Days where admissions per RN exceeded 125% of the ward mean were associated with an increased hazard of death (aHR 1.05, 95% CI 1.01 1.09). Although low nursing assistant staffing was associated with increases in mortality, high nursing assistant staffing was also associated with increased mortality. CONCLUSION: Lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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