| 1. |
- Alenius, Lisa Smeds, et al.
(författare)
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Between a rock and a hard place : Registered nurses' accounts of their work situation in cancer care in Swedish acute care hospitals
- 2020
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Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 47
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Hospital organizational features related to registered nurses' (RNs') practice environment are often studied using quantitative measures. These are however unable to capture nuances of experiences of the practice environment from the perspective of individual RNs. The aim of this study is therefore to investigate individual RNs' experiences of their work situation in cancer care in Swedish acute care hospitals.Methods: This study is based on a qualitative framework analysis of data derived from an open-ended question by 200 RNs working in specialized or general cancer care hospital units, who responded to the Swedish RN4CAST survey on nurse work environment. Antonovsky's salutogenic concepts "meaningfulness", "comprehensibility", and "manageability" were applied post-analysis to support interpretation of results.Results: RNs describe a tension between expectations to uphold safe, high quality care, and working in an environment where they are unable to influence conditions for care delivery. A lacking sense of agency, on individual and collective levels, points to organizational factors impeding RNs' use of their competence in clinical decision-making and in governing practice within their professional scope.Conclusions: RNs in this study appear to experience work situations which, while often described as meaningful, generally appear neither comprehensible nor manageable. The lack of an individual and collective sense of agency found here could potentially erode RNs' sense of meaningfulness and readiness to invest in their work.
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| 2. |
- Leineweber, Constanze, et al.
(författare)
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Nurses’ practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction : A multi-country, multilevel study
- 2016
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 58, s. 47-58
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundNursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied.ObjectiveThe aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction.DesignMultilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied.ResultsRegarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied.ConclusionsWe conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries.
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| 3. |
- Skyttberg, Niclas, et al.
(författare)
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Sound psychometric properties of a short new screening tool for patient safety climate : applying a Rasch model analysis
- 2023
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: WHO recommends repeated measurement of patient safety climate in health care and to support monitoring an 11 item questionnaire on sustainable safety engagement (HSE) has been developed by the Swedish Association of Local Authorities and Regions. This study aimed to validate the psychometric properties of the HSE.Methods: Survey responses (n = 761) from a specialist care provider organization in Sweden was used to evaluate psychometric properties of the HSE 11-item questionnaire. A Rasch model analysis was applied in a stepwise process to evaluate evidence of validity and precision/reliability in relation to rating scale functioning, internal structure, response processes, and precision in estimates.Results: Rating scales met the criteria for monotonical advancement and fit. Local independence was demonstrated for all HSE items. The first latent variable explained 52.2% of the variance. The first ten items demonstrated good fit to the Rasch model and were included in the further analysis and calculation of an index measure based on the raw scores. Less than 5% of the respondents demonstrated low person goodness-of-fit. Person separation index > 2. The flooring effect was negligible and the ceiling effect 5.7%. No differential item functioning was shown regarding gender, time of employment, role within organization or employee net promotor scores. The correlation coefficient between the HSE mean value index and the Rasch-generated unidimensional measures of the HSE 10-item scale was r = .95 (p < .01).Conclusions: This study shows that an eleven-item questionnaire can be used to measure a common dimension of staff perceptions on patient safety. The responses can be used to calculate an index that enables benchmarking and identification of at least three different levels of patient safety climate. This study explores a single point in time, but further studies may support the use of the instrument to follow development of the patient safety climate over time by repeated measurement.
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| 4. |
- Smeds Alenius, Lisa
(författare)
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Conditions for care : factors in the nurse work environment related to safe and high quality care in acute care hospitals
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Shortages of registered nurses (RNs) intensify challenges for healthcare service providers in matching an increasing demand for care with a sufficient healthcare workforce. Poor working conditions have been recognized to often precede RNs’ decision to leave the profession prematurely. Since job dissatisfaction has been shown to be related to negative outcomes for patients, investigating working conditions may provide valuable insights for healthcare service providers in their efforts to improve recruitment and retention of RNs to sustain care quality and safety for patients. However, there was limited knowledge in research about the work conditions needed for care provision from the perspective of RNs themselves. The overarching aim of this thesis is to investigate RNs’ experiences of their work environment – as persons, as professionals, and as employees – and how their experiences are related to patient safety, quality of care, and conditions for patient care delivery. This thesis is based on data derived from the Swedish component of the cross-sectional, multi-national EU 7th framework project Registered Nurse Forecasting (RN4CAST). Swedish data include survey responses from a national sample of 11 015 RNs working in inpatient care on medical/surgical wards in all acute care hospitals in Sweden, patient data from the national discharge register, and data on hospital characteristics. Results show that hospital structural factors such as size, geographical location, and teaching status, had relatively little influence on RNs’ assessments of their work environment, work situation and the quality of care. Factors with the most influence on RNs’ assessments of patient safety on their ward were modifiable, related to their perception of adequate staffing and resources, hospital management prioritizing patient safety, supportive nurse leadership, and good working relations with physicians. RN-assessments of excellent patient safety and quality of care on their ward related to considerably lower odds of patients dying within 30 days of admission. In their own accounts, RNs described experiencing expectations and demands – from management, patients and their families, other staff groups, the RN profession as well as their own individual ambitions – to uphold standards of safe, high quality care. However, they also described working in an environment with little means of influencing the conditions needed to meet these demands. The tensions between expectations and demands on one hand, and lack of influence on the other, seemed to lead to RNs’ lacking a sense of agency, on both individual and collective levels. This thesis indicates that RN-assessments of excellent patient safety and quality of care can be useful as valid hospital-level indicators to inform policy-decisions on patient care. However, inadequacy of important conditions for providing safe care (e.g. adequate staffing and resources) as well as the lack of a sense of agency suggests organizational factors might impede RNs’ ability to use their entire range of professional competence in care provision and to govern their own scope of practice. In efforts to improve RN retention and to ensure safe, high-quality care to patients, hospital organizations could use these research findings to identify and foster organizational conditions that support RNs’ full professional contribution to patient care.
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| 5. |
- Svensson, Ingrid, et al.
(författare)
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Unfolding alignment - How top management work to align demand and capacity : an ethnographic study of resilience in a Swedish healthcare region.
- 2023
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Resilient healthcare organizations maintain critical functions and high-quality care under varying conditions. While previous research has focused on the activities of frontline healthcare professionals working at the "sharp end" of care, less attention has been paid to managers at the top management level. More knowledge is needed to fully understand how the managers align demand and capacity at the "blunt end" of care. Therefore, this study aimed to explore how top managers work to align demand and capacity in a healthcare region in Sweden.METHODS: Observations of management team meetings, interviews, and conversations were conducted with top managers responsible for healthcare in one of Sweden's 21 regions. Data collection used an ethnographic approach. Data were analyzed using qualitative reflexive thematic analysis.RESULTS: The data showed how alignment work was done through active reflection that built on past experiences and on structures built into the organization at the same time as taking future potential outcomes and consequences into account. In addition to collaborative, preventive, supportive, and contextualizing work, which was conducted in the present, a general approach permeated the organization, which enabled connecting actions, i.e., different forms of alignment work, occurring at different points in time, and connecting different types of knowledge across organizational borders and stakeholders.CONCLUSION: This study explored how top managers work to align demand and capacity in a healthcare region in Sweden. It was shown how four categories of work; collaborative, preventive, supportive and contextualization work, together with a general approach; focusing on opportunities, building on a stable past and taking a reflective stance, constitute alignment in practice. More; the alignment work was done in the here and now, with both the past and future in mind. The ability to take action to benefit the whole is a possibility and a responsibility for top management. In the region studied, this was done by aligning demands with capacity based on past experiences and focusing on the available opportunities to connect knowledge needed within and across organizational borders.
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