48 research outputs found
Predicting nurses' job satisfaction and ethical practice from job characteristics.
No full textOutcomes related to redesign of nursing jobs in response to cost containment pressures have not been well explored. An increase in job satisfaction and enhanced work performance are two predicted outcomes. Nurses' ethical practice was conceptualized as one aspect of work performance for the purpose of this study. The purpose of this study is to examine and test a model of the relationships between seven job characteristics (feedback from agents, autonomy, dealing with others, feedback from the job itself, skill variety, task identity, and task significance), nurses' job satisfaction, and nurses' ethical practice. Professional experience, growth need strength, and context satisfactions (satisfaction with pay, job security, coworkers, and supervisors) were investigated to determine their moderating effects on the relationships between job characteristics and two outcomes: nurses' job satisfaction and nurses' ethical practice. The job characteristics theory of Hackman and Oldham (1980) provided a framework for this research. The study was a secondary analysis of data from a larger, longitudinal study. Data were collected from 398 staff nurses employed by a large, Midwestern tertiary medical center. Measures included the Job Diagnostic Survey (Hackman & Oldham, 1980), the Judgments About Nursing Decisions (Ketefian, 1987), and a personal information questionnaire. There are three major findings of this study. First, all seven job characteristics predict nurses' job satisfaction. Second, there is evidence that professional experience, growth need satisfaction, satisfaction with pay, satisfaction with job security, satisfaction with coworkers, and satisfaction with supervision moderate some relationships between job characteristics and job performance and between job characteristics and ethical practice The results are not consistent across all moderators and all job characteristics and are not always in the expected direction. Third, job characteristics and job satisfaction do not influence nurses' ethical practice. While job characteristics and job satisfaction do not explain any of the variance in ethical practice, this finding has positive implications for patients, nurses, and health care organizations. Despite concerns about negative consequences of nurses' job redesign, nurses in this study perceived that nurses are realistically likely to take appropriate action in response to common ethical dilemmas in practice.PhDHealth and Environmental SciencesHealth care managementNursingOccupational psychologyPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131292/2/9840615.pd
Causal relationships among antecedent variables, work stress, and ethical decision-making.
No full textThe present study explored the causal relationships among nurses' autonomy, st and ardization, individual traits (locus of control, age, experience, education), nursing role conception, moral reasoning, work stress, and ethical decision making by constructing and testing a theoretical framework. Based on Kahn, Wolfe, Quinn, and Snoek's (1964) theory of stress and Kohlberg's (1978) theory of moral development, nurses' work stress and ethical decision making were conceived of as outcomes of the interplay between personal characteristics and work environment. Personal aspects associated with work stress and ethical decision making included locus of control, education, age, experience, nursing role conception, and moral reasoning. The work environment factors involved autonomy and st and ardization. Using the data which were collected for the study titled "Professional and bureaucratic role conceptions and moral behavior of nurses" conducted by Ketefian (1985), the present study tested a series of hypotheses and a conceptual model. The total sample for the study included 224 registered nurses. Basically two kinds of research methodologies were employed to examine the hypotheses. First, the linear structural relations (LISREL) technique was used to test the fit of the proposed conceptual model to the data and examine the causal relationships among the variables. Second, correlational analyses were executed to check for the moderating effects of demographic variables (i.e., age, experience, and education) on particular relationships between two variables. The results showed that all the developed six models fit the data moderately, revealing considerable explanatory power for each of the endogenous variables. In predicting nurses' work stress and ethical decision making, the findings of this study clearly demonstrated that autonomy as an environmental factor might be much more important than personal factors. Also, professional and service role conceptions were found to be the most important factors in predicting nurses' ethical decision making. The results were discussed noting the limitations of the study. Practical implications drawn from the research were suggested. Finally, directions for future research were presented.PhDNursingUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/162332/1/9001660.pd
Relational demography, perceptions of organizational culture, and affective outcomes among registered nurses.
No full textThis study explores the relations among relational demography and organizational outcomes in a sample of registered nurses (RNs). In addition, the mediating effect of organizational culture between relational demography and organizational outcomes was explored. Similarity on the demographic characteristics of age, sex, employment status, race/ethnicity, and tenure were investigated. The organizational outcomes in the study were job satisfaction and organizational commitment. The organizational culture attributes accomplishment, affiliation, power, recognition, and strength of culture were the mediating variables. Several theories provided the framework for this study including theories on nursing, relational demography, social identity, social-categorization, similarity-attraction, and organizational culture. Three hundred and eighty one subjects from 150 units, clinics, and research areas participated in the study. Each subject completed the Nurse Assessment Survey (Redman & Ketefian, 1995) which incorporated parts of Spectrum, an organizational and individual development tool (Braskamp & Maehr, 1988). Multiple correlations and multiple regressions were used to analyze the study data. Results indicated that of the five relational demography characteristics, only sex similarity was positively and significantly associated with job satisfaction and organizational commitment. The organizational culture attributes of affiliation and recognition partially mediated the relationship between sex similarity and job satisfaction. Accomplishment, recognition, and strength of culture partially mediated the relationship between sex similarity and organizational commitment. Power was negatively and insignificantly associated with sex similarity. This research supports, albeit tentatively, relational demography in that job satisfaction and organizational commitment were affected by the sex composition of work units. The sex similarity of RNs was positively and significantly associated with RNs' perceptions of the health care system's culture. Further, organizational culture attributes functioned as partial mediator variables to explain job satisfaction and organizational commitment among RNs.PhDBehavioral psychologyHealth and Environmental SciencesManagementNursingPsychologySocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/123721/2/3096217.pd
The structure and organization of expert nursing knowledge: Monitoring the surgical intensive care patient.
No full textThis study addressed the phenomenon of nursing expertise by focusing on the knowledge that underlies the practice of the expert clinician. Nurses are confronted daily with the task of monitoring patients and orchestrating an effective response if significant changes in a patient's status occur. Although clinicians routinely assume this responsibility, very little is known about the knowledge that underlies successful execution of this task. The purpose of this study was to explore and describe the knowledge that expert surgical intensive care nurses use to help them make decisions and judgments in their responsibilities of monitoring patients. Ethnography, specifically linguistic analysis, provided the design framework for the investigation. A purposive sample of eight nurses served as informants for this study. The participants, all of whom had at least five years experience caring for critically ill surgical patients, were identified as expert clinicians by SICU supervisors. Data were collected via interview and participant observation. The language experts used in the clinical environment to describe the clinical task of monitoring patients, was analyzed using four interlocking procedures of domain analysis: domain identification, taxonomic analysis, componential analysis, and thematic analysis. Five individual domains of knowledge were identified and described: (1) different kinds of patients, (2) different kinds of numbers, (3) bad signs, (4) putting the picture together and (5) ways to contact the physician. Three themes which integrated individual domains into a coherent knowledge system were identified: (1) successful monitoring depends upon minimizing the impact of error on the assessment process, (2) successful monitoring depends on anticipation: timing is everything, and (3) successful monitoring depends upon knowing when to worry, how worried to get and how to convince the physician to be as worried as you are. Taken as a whole, the participants' knowledge base was organized so that information relative to assessment was indexed and mapped onto information about appropriate actions. Domain content was also affectively coded. The findings suggest that the intuitive quality of expert performance in the monitoring situation may be explained by the particular way that clinical knowledge is structured and organized.PhDHealth and Environmental SciencesNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129284/2/9423251.pd
Nursing interventions to reduce unilateral neglect in right hemisphere stroke patients.
No full textUnilateral neglect is described as the failure of an individual, despite normal primary sensation, to report, respond, or orient to novel or meaningful stimuli presented to the side opposite the brain lesion (Heilman & Valenstein, 1979). Heilman and associates (1985) proposed that neglect is an attention-arousal deficit due to decreased activation of the right hemisphere. The purpose of this study was to determine whether selected interventions that increase the activation of the damaged right hemisphere will reduce the severity of unilateral neglect on the left. The study sample consisted of an experimental and a control group composed of right hemisphere stroke patients with evidence of unilateral neglect. Subjects were recruited from a rehabilitation center in the southern region of the U.S. Three tests of unilateral neglect were used: line bisection, visual target cancellation, and letter reading. Anosognosia was also assessed. Experimental group subjects received the following interventions daily for 15 minutes over a 3-week period: dynamic visual stimuli were presented on the left side of the subject, music was delivered to the subject's left ear through headphones, and the subject received tactile stimuli by the investigator brushing the upper left extremity with a rough cloth. The experimental subjects were tested for unilateral neglect every 3 days before and after each intervention. Control subjects did not receive any interventions; they were tested and then retested 15 minutes later every 3 days. Repeated measures ANOVA were used to test the two study hypotheses; both were rejected. There were no significant effects of the interventions on the severity of unilateral neglect immediately after the interventions were terminated, nor did they have any carryover effect, even after several weeks of intervention. During the implementation of the interventions, however, the severity of left-sided neglect was significantly reduced. This finding has implications for rehabilitation of right hemisphere stroke patients.PhDBiological SciencesHealth and Environmental SciencesNeurosciencesNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/128735/2/9135549.pd
Arthritic elders' psychological well-being as influenced by pain, functional impairment, self-efficacy, and social support.
No full textAn important nursing role is to assist older adults with arthritis to manage arthritis pain and disability and maintain psychological well-being. The purpose of this study was to test a proposed theoretical model, based on Lazarus's theory of stress and coping, which explained the psychological well-being (PWB) of older adults with arthritis as influenced by arthritis pain, functional impairment, satisfaction with comfort, satisfaction with functional ability, pain self-efficacy, general self-efficacy, and social support. A descriptive, correlational design was used. The sample consisted of 202 community residing veterans who were age 60 years and older, had self-reported arthritis, and attended the outpatient clinic of a large Veterans Affairs medical center. Data were collected through interviewer administered self-report questionnaires which addressed pain, functional impairment, satisfaction with comfort, satisfaction with functional ability, pain self-efficacy, general self-efficacy, social support, PWB, general health characteristics, and arthritis characteristics. The questionnaires were completed by interviewers at the clinic or by telephone. Path analysis procedures were used to test the proposed model. The causal model was empirically supported, with the exception of four hypothesized paths which were not statistically significant. Satisfaction with functional ability, pain self-efficacy, general self-efficacy, and social support explained 51% of the variance in PWB. Pain indirectly affected PWB via functional impairment. Functional impairment indirectly affected PWB via satisfaction with functional ability. Satisfaction with comfort did not predict PWB. Satisfaction with functional ability, pain self-efficacy, general self-efficacy, and social support were important influences in maintaining the psychological well-being of older adults with arthritis. The finding that functional impairment was a greater determinant of psychological adjustment to arthritis than was pain indicates that older adults' functional ability is an important area for nursing practice and future research.PhDHealth and Environmental SciencesNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129393/2/9501055.pd
Environmental and personal predictors of professional nursing practice behaviors in hospital settings.
No full textThe purpose of the study was to test a theoretical model explaining how selected environmental and personal factors affect hospital nursing practice behaviors. Many hospital nurses perform isolated, routine tasks, rather than use their professional training because they are subject to control by organizational and medical divisions of labor. The environment may interfere with nurses' ability to practice autonomously, and according to professional standards. Nursing may not be an attractive career option because of the task-centered focus of a lot of nursing work, and patient outcomes may be adversely affected by task-oriented behaviors. The study used a non-experimental, comparative design. Surveys were sent to a random sample of 500 nurses in Michigan. Four instruments, measuring structural empowerment, self-efficacy, professional nursing practice, and nursing leadership were included. Path analysis was used for statistical analysis. Three hundred and sixty-four nurses responded (73%), of which 266 provided usable protocols for the final analysis. Findings did not support the theoretical model as proposed, but an alternative model emerged. Environmental factors (structural empowerment) contributed both directly to professional practice behaviors and indirectly through self-efficacy. Self-efficacy mainly exerted its effect as a mediator in the relationship between environmental factors and practice behaviors. Level of education and specialty certification were also found to positively affect practice behaviors directly. Nursing leadership had an indirect impact only, and helped to predict 46% of the variance in the overall model explaining nursing practice behaviors. Nurses may practice more professionally when the environment provides opportunities and power through resources, support, and information. Self-efficacy may contribute to professional practice behaviors, especially in an environment that has the requisite factors that provide empowerment, and where strong nursing leadership exists. Strong nursing leadership may influence nurses' self-efficacy by providing more access to structural empowerment factors. Future research should continue testing of the revised theoretical model to be able to fully understand professional nursing practice behaviors, and incorporate the impact of those behaviors on patient outcomes.PhDHealth and Environmental SciencesNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/123903/2/3106118.pd
Nurse staffing and adverse patient outcomes.
No full textIn the past several years, there has been public concern that inadequate nurse staffing may jeopardize the quality of patient care and increase medical errors. In response to this growing concern, this study examined the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Using a cross-sectional study design, 232 acute care hospitals in California and the patients they discharged in 1997 were included. Nurse staffing was quantified using four measures: All Hours (hours worked by all nursing personnel per patient day); RN Hours (hours worked by registered nurses per patient day); RN Proportion, (proportion of hours worked by registered nurses); and Contracted Hours (proportion of hours worked by temporary contract nursing personnel). Adverse events included patient falls/injuries, pressure ulcers, adverse drug events, pneumonia, urinary tract infections, wound infections, and sepsis. Multivariate analyses found statistically significant relationships between hospital characteristics and nurse staffing. A greater average nursing intensity that reflects the level of nurse workload was associated with greater All Hours. Medium-sized hospitals (100--299 beds) had the lowest mean All Hours and RN Hours. Investor-owned hospitals used more Contracted Hours than did non-profit hospitals. Patient characteristics (e.g., number of diagnoses, type of admission) significantly affected the occurrence of adverse events. Among the seven adverse events studied, nurse staffing had a significant inverse relationship only with pneumonia. An increase of one RN Hour was associated with an 8.9% decrease in the predicted odds of pneumonia. Similarly, a 10% increase in RN Proportion corresponded to a 9.5% decrease in the odds of pneumonia. Having each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization. Having pneumonia was associated with a 1.74-fold increase in length of stay, a 3.39-fold increase in the odds of mortality, and a 1.84-fold increase in costs. These findings suggest that patients are experiencing avoidable, preventable adverse events during hospitalization. Hospitals and nurses, as patient advocates, need to develop safe care systems to reduce adverse events and their consequences.PhDHealth and Environmental SciencesHealth care managementNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129289/2/3042055.pd
Predictors of nurse turnover: Model development and testing
No full textPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88190/1/ketefian-predictors_of_nurse_turnover.pd
