RESUMEN
OBJECTIVE: Moral distress emanating from value conflicts comprising ethical dimensions pose a threat to nurses' health and retention, as well as to the quality of care. The aim of the present study was to investigate the relationships between the frequency of ethical value conflicts (EVC), and the perceived distress when they occur, respectively, and nurses' work-related stress, burnout symptoms, turnover intent, team effectiveness, and patient safety. METHODS: A two-wave longitudinal cohort questionnaire study was performed among registered nurses at six hospitals in two Swedish regions. Cross-sectional analyses (T1) were based on 1817 nurses in 228 care units (CU), and longitudinal analyses (T1 - T2) on 965 nurses in 190 CU. Hypothesis testing was performed using multilevel controlled regression modeling. RESULTS: The results indicated that nurses who were often exposed to EVC also to a higher extent tended to report these conflicts as stressful. Frequent exposure to EVC induced by insufficient resources, inapt organizational structures or interpersonal staff relations were cross-sectionally associated with work-related stress, burnout symptoms, turnover intent, and team effectiveness. The longitudinal analyses indicated that EVC induced by a lack of resources primarily had negative effects on nurses' health and well-being. At the CU level, such conflicts also impaired team effectiveness. At the individual level, EVC induced by organizational constraints or interpersonal relations negatively affected care effectiveness. CONCLUSIONS: EVC are related to negative consequences in healthcare, and such processes take place both on the individual and organizational levels.
Asunto(s)
Agotamiento Profesional , Enfermeras y Enfermeros , Personal de Enfermería en Hospital , Estrés Laboral , Humanos , Estudios Transversales , Actitud del Personal de Salud , Relaciones Interpersonales , Encuestas y Cuestionarios , Satisfacción en el TrabajoRESUMEN
AIM: To explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts. DESIGN: A mixed methods design with a longitudinal questionnaire survey and focus group interviews. METHODS: A questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November-January 2019/2020 and November-January 2020/2021). A cross-lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April-October 2021). Qualitative data collection and analysis were inspired by Grounded Theory. RESULTS: A climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur. CONCLUSION: It is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve. IMPLICATIONS FOR THE PROFESSION: By ensuring a shared care ideology, good inter-professional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful. IMPACT: The study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
Asunto(s)
Actitud del Personal de Salud , Enfermeras y Enfermeros , Humanos , Estudios Prospectivos , Grupos Focales , Encuestas y Cuestionarios , Principios MoralesRESUMEN
AIM(S): This study aims to investigate care unit managers' perceptions of how the COVID-19 pandemic influenced their ability to support the nurses. BACKGROUND: The COVID-19 pandemic placed extreme pressure on health care organizations. More knowledge regarding how the pandemic influenced care unit managers' ability to support nurses is central to ensuring high-quality health care in future crises. METHOD(S): A mixed-methods study in Swedish hospitals with a survey (n = 128) and interviews (n = 20) with care unit managers. RESULTS: Approximately half of the managers reported having spent more time available to and supporting the nurses. Availability was positively predicted by their perceived organizational support while negatively by their job demands. These job demands concerned meeting staff anxiety and managing organizational restructuring. Full focus on direct patient care and strong professional and social support were important job resources. CONCLUSION(S): For care unit managers to effectively support the nurses during a crisis, they need proficient job resources and moderate job demands. Managers' perceived organizational support positively affects the quality of their crisis leadership. Creating arenas in which staff collegiality can form and develop is beneficial for the ability to meet future crises. IMPLICATIONS FOR NURSING MANAGEMENT: This study specifies important job resources that should be acknowledged and reinforced to strengthen the ability of care unit managers to actively support the nurses during a crisis.
Asunto(s)
COVID-19 , Enfermeras Administradoras , Humanos , Pandemias , Satisfacción en el Trabajo , COVID-19/epidemiología , Encuestas y Cuestionarios , Liderazgo , Atención a la SaludRESUMEN
Healthcare unit managers are pivotal to promote nurses' Perceived Organizational Support and hence to ensure nurses' health and well-being, as well as high-quality care. Despite this fact, there is a dearth of studies addressing how healthcare unit managers act and organize their work to promote nurses' Perceived Organizational Support and which working conditions enable them to do so. Through a mixed methods approach, comprising qualitative interviews and quantitative surveys among healthcare unit managers and nurses, this paper underscores that healthcare unit managers' availability to their nursing staff was essential for their ability to promote nurses' Perceived Organizational Support, and that responsive support from the care unit managers' superior management, administration, and managerial colleagues constituted enabling working conditions. Superior manager support strongly promoted the care unit manager's own Perceived Organizational Support, which, in turn, was positively correlated with nurses' organizational climate of Perceived Organizational Support.
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Enfermeras Administradoras , Humanos , Encuestas y Cuestionarios , Atención a la Salud , Liderazgo , Satisfacción en el Trabajo , Cultura OrganizacionalRESUMEN
PURPOSE: The purpose of this paper is to inductively explore the context-specific preconditions for nurses' perceived organizational support (POS) in healthcare organizations. DESIGN/METHODOLOGY/APPROACH: A qualitative interview study was performed, based on the critical incident technique (CIT), with 24 registered nurses in different specialities of hospital care. FINDINGS: The nurses perceived three actors as essential for their POS: the first-line manager, the overarching organization and their college. The preconditions affecting the nurses' perceptions of organizational support were supportive structuring and structures at work, as well as individual recognition and professional acknowledgement. ORIGINALITY/VALUE: Previous studies of POS have mostly had a quantitative outset. In this paper, context-specific preconditions for nurses' POS are described in depth, enabled by the qualitative approach of the study. The findings may be used to guide healthcare organizations and managers aiming to foster nurses' POS, and thereby, benefit nurses' well-being and retention, as well as healthcare quality and efficiency.
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Enfermeras y Enfermeros , Personal de Enfermería en Hospital , Atención a la Salud , Instituciones de Salud , Humanos , Investigación Cualitativa , Calidad de la Atención de SaludRESUMEN
Purpose The purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement (QI) work. Design/methodology/approach Qualitative case study based on interviews ( n=27) and observations ( n=10). Findings The main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships. These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work. However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute. Practical implications Understanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed. Originality/value Healthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.
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Empleos en Salud , Personal de Salud/psicología , Cultura Organizacional , Mejoramiento de la Calidad/organización & administración , Compromiso Laboral , Humanos , Relaciones Interprofesionales , Investigación Cualitativa , Calidad de la Atención de Salud/organización & administraciónRESUMEN
This article reports on the involvement of nurses and physicians in improvement work, with a special focus on the drivers. The purpose was to describe how the nurse and physician groups understand involvement drivers for improvement work and to explain the differences in how they understand involvement. The study was conducted at 2 Swedish hospitals, and a total of 20 nurses and 10 physicians were interviewed. The theoretical framework, developed by an interpretative approach, identifies and describes a number of involvement drivers. On clustering the drivers into larger involvement factors, the study shows clear differences and profiles in terms of the 2 groups' perception and understanding of the involvement-drivers. Each group's profile was then analyzed on the basis of concept of professional culture.