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Psychiatric Nurses’ Self-Efficacy on Smoking Cessation Service - An Exploratory Study
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Department of Nursing 98 1 99
() t2696107
2010-01-26 95 -
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Psychiatric nurses Smoking cessation Smoking Smoking cessation service Self efficacy
20077112009111 1819340 1.55.572.3.4. In Taiwan, THPCA (Tobacco Hazards Prevention Act) was declared on July 11th, 2007, and enforced on January 11th, 2009. The actual situation regarding the smoking cessation services becomes an important issue for psychiatric nurses. The study explored the condition of psychiatric nurses’ self efficacy in providing smoking cessation services in Taiwan. Further analyses were also performed to explore the relation of their self efficacy in terms of demographic variables, attitudes toward patients smoking, the policy, and the practice of smoking cessation service. The study was designed by a crosssectional method. Purposive sampling was used to recruit health care providers who take care of psychiatric patients in central and southern Taiwan. A total of 193 participants completed 40 questions in a structured questionnaire. The data was analyzed by the methods of descriptive statistics, Pearson’s correlation, ANOVA and multiple regressions. The results are as follow: 1. Nurses reported a moderate level of their self efficacy in providing smoking cessation service (M=55.57). 2. If clients obtain a higher motivation in quitting smoking and accept the smoking cessation service, and lower barriers in smoking cessation service offering, the self efficacy of Psychiatric nurses will increase. 3. Nurses with a higher frequency of offering smoking cessation service and agreement with the smoking free policy, and less experience of second hand smoking in workplace would obtain a higher self efficacy. 4. The barrier of smoking cessation offering, the experience of second-hand smok in workplace , whether the providers agree or disagree that smoking can allow the client to self-medicate, the assessment of clients’ motivation for quitting smoking, and the frequency of providing and talking the smoking cessation service with patient were predictive variables of self efficacy. The The results of this study allowed us to understand the patients’ motivation for quitting smoking, the frequency of smoking cessation service offering, workplace environment and self efficacy which is affecting each other. Additionally, findings from the present study could help us design the tobacco ceasing program and assist in future policy making for mental health care providers in the future. ………………………………………………………………………………… ……………………………………………………………………………… …………………………………………………………………………………… ……………………………………………………………………………1 ………………………………………………………………1 ………………………………………………………………………4 ………………………………………………………………………5 ………………………………………………5 …………………………………………7 ……………………………………………9 ………………………………………………11 ……………………………………………………………12 ……………………14 …………………………………………………………………14 ……………………………………………15 ……………………………………………………17 ……………………………………………………………………21 …………………………………………………………………21 …………………………………………………………………22 ……………………………………………………24 ………………………………………………………………25 …………………………………………………………………26 …………………………………………………………………30 …………………………………………………………………31 ……………………………………………………………32 ……………………………………………………………………33 …………………………………………………………………33 ...37 ...39 ………………44 …………47 ……………………49 …………………………………………………………………………55 ……………………………………………………………55 ………………………58 …59 ……………………62 ………64 ……………………65 ………………………………………………66 …………………………………………………70 …………………………………………………………………………70 …………………………………………………………………………71 ……………………………………………………………………73 ………………………………………………………………………………74 ....84 ...................................................................85 ....................................................86 1989• • 2008• • 2009 1120http://www.tma.tw/stats/stats12.asp 2009a• 96• 2009 1124http://olap.bhp.doh.gov.tw/Search/ListHealth1.aspx?menu= 1&mode=8&year=96&sel=0 2009b• 94• 2009 1124http://olap.bhp.doh.gov.tw/Search/search3.aspx?menu= 1&mode=1&year=94&areaId=&areaValue=&addType=&TarId=154 2009c• • 20091124http://www.bhp.doh.gov.tw/BHPnet/ Portal/AnnounceShow.aspx?No=200905060002 2009d• • 2009 32http://www.health.url.tw/nosmoke/detail.php?catid=12&id=118 2009e• - • 2009 1219 http://www.bhp.doh.gov.tw/BHPnet/Portal/PressShow.aspx ?No=200912170001 2009f• • 2009 1223http://tobacco.bhp.doh.gov.tw/Show.aspx?MenuId=317 2008• 2008 • : 2007629a • 2007 • 2008 45http://tobacco.bhp.doh.gov.tw/Upload/Documents/52d6b56bba294 c6480a1.pdf 2007711b• • 2008 1215http://health99.doh.gov.tw/documents/.pdf 2007• • 2531-56 2007• SPSS • 2005• SPSS• 2000• • 2000• • • 1995• 1977 2004• • 2007• • 1237- 43 2003• • 1982• - • 1977 2001• • 12 (1)31-41 1993• • 1 (3)231-246 1991• • 1996• • 43368-72 1994• • 20081215http://dict.revised.moe.edu.tw/cgi-bin/newDict/dict.sh?idx=dict.idx&cond=%ABH%A9%C0&pieceLen=50&fld=1&cat=&imgFont=1 2003• • 50(5)74-78 2000• • 2008• • 20081215http://www.e-quit.org/smokeless/smokerepel_2.aspx 2007• • 9 (3)210-221 2003• • 2006• ,SPSS • 2004 • • 51267-72 2009• • 13(3)223-230 2003• 2001 • 226453-464 Corey, G.2005• • 2001 Egan, G.2004•2002 Applegate, B. 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B., Potapova, N., & Kennedy, J. L. (2007). Association of 42 nicotinic receptor and heavy smoking in schizophrenia. Journal of Psychiatry Neurosci, 32(6), 412-416. Wetta-Hall,R., Ablah, E., Frazier, L.M., Molgaard, C.A., Berry, M., & Good, M. J. (2005). Factors influencing nurses’ smoking cessation assessment and counseling practices. Journal of Addictions Nursing, 16, 131-135. Willaing, I., & Ladelund, S.(2004). Smoking behavior among hospital staff still influences attitudes and counseling on smoking. Nicotine and Tobacco Research, 6, 369- 375. Worth Health Organization (2008). WHO REPORT on the global TOBA CCO epidemic- The MPOWER package. GenevaWHO. Zapka, J. G., Pbert, L. P., Stoddard, A. M., Ockene, J. K., Goins, K. V., & Bonollo, D. (2000). Smoking Cessation Counseling With Pregnant and Postpartum Women: A Survey of Community Health Center Providers. American Journal of Public Health, 90(1), 78-84.
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Assessment of Job Strain and mental health effect in Nursing Staff in Taiwan
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Institute of Environmental and Occupational Health 92 1 93
() s7690114
2004-01-13 69 -
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nurses demand control effort assault reward depressive syndrome
604204624(Chinese Version of the JCQC-JCQ)(Effort Reward imbalanceERI)(Taiwanese Depression QuestionnaireTDQ) 540490(E/R ratio>1)14.8 %16.7%(AOR=3.32, 95%CI=1.06-14.72)(AOR=2.10, 95%CI=1.03-4.65)21.8 %24.0%(AOR=4.00, 95%CI=1.15-18.89) (AOR=2.11, 95%CI=1.223.80)(AOR=1.87, 95%CI=1.00-4.71) 20420032002 ObjectivePrevious literatures suggest that job stress in nurses can be caused by heavy workload, shift work, emergency, needle stick and infectious disease. A significant relationship was found between job stress and depression, frustration, hopelessness, job dissatisfaction and burnout in nurses. The objective of this study is to assess the association between job stress and nurses’ subjective perception of mental health. Methods Our participants are nurses working in 5 psychiatric hospitals and 4 general hospitals in Taiwan. A structured questionnaire has been designed. Job stress questionnaire was based on the conceptual framework of job stress model- Karasek’s demand-control model (JCQ), Johannes Siegrist’s effort-reward imbalance model (ERI) and added items of job stressors which included assault and shirt work. The mental health status will be assessed by the Taiwan Depression Questionnaire (TDQ). ResultsA total of 1030 questionnaires were completed . In psychiatric hospitals, the 14.8% of the nurses were in the effort-reward imbalanced group and the 16.7% were depressive syndrome. Working in direct patient care was associated with effort-reward imbalanced than administrative nurse and rotating shirt work was associated with poor mental health. A total of 21.8% nurses had effort-reward imbalanced and 24.0% had depressive syndrome in general hospitals. Working in direct patient care and rotating shirt work were associated with effort-reward imbalanced and less than 5 working tenure was associated with poor mental health. Depressive syndrome is not different between nurses in psychiatric and general hospitals after adjusting for age variable. Younger age groups seem to suffer more depressive syndrome. High demand and low control is a risk factor for depressive syndrome in nurses. High effort and low reward is also a risk factor for depressive syndrome in nurses. In those 204 nurses followed up from 2002, JCQ results showed increased supervisor support scores than first testing. ConclusionNurses in general hospitals have higher effort-reward imbalanced then nurses in psychiatric hospitals. Younger age groups seem to suffer from more depressive syndrome in two kinds of hospitals. As measured by JCQ and ERI model, job strain is a risk factor for depressive syndrome in nurses. 1 1 3 4 4 2.1.1 4 2.1.2 5 2.1.3 7 2.1.4 8 9 2.2.1 9 2.2.2 10 2.2.3 11 14 2.3.1 14 2.3.2 15 2.3.3 15 2.3.4 17 18 18 18 18 21 21 23 23 24 26 26 27 28 28 30 30 30 32 33 34 35 35 37 37 39 6.2.1 39 6.2.2 39 6.2.3 39 6.2.4 40 6.2.5 40 6.2.6 40 41 42 43 48
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The Turnover Intention of Nurses- A Study of a Regional Teaching Hospital in Tainan Area
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(EMBA)
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Executive Master of Business Administration (EMBA) 95 2 96
() r0793107
2007-06-01 61 -
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Organizational support Loyalty Job satisfaction Turnover intention Nurses
Health care system is one of the major determinants in improving people health. For the purpose of providing medical service, it increases not only medical facility, but also the health care providers. The nurse turnover rate is high in Taiwan. High turnover rate of nurses lead to poor care quality, and patient safety. Job satisfaction is a main reason for quitting job. Loyalty has the same effect on turnover. There are not many studies to explore the relations between job satisfaction, loyalty and turnover intention of nurses. In this article, we try to figure out this relation of these three factors. Nurses work in the non-profit organization and can not share bonus from their production. Organizational support is another influencing factor other than job satisfaction and loyalty. The results of this study discover that job satisfaction has a negative relation to turnover intention, and also loyalty has a negative relation to turnover intention among the nurses. Job satisfaction has a positive relation to loyalty. Loyalty has a mediator effect on the path between job satisfaction and turnover intention. Organizational support has a moderate effect on the path between job satisfaction and loyalty. The findings make the managers can manipulate the organizational support in order to increase the loyalty and decrease the turnover intention. ............................................1 ..................................1 ........................................2 ........................................3 ........................................5 ........................................6 ................................6 (Turnover Intention)....................9 .......................................12 Organizational support...15 .............................17 .......................................18 .......................................19 ...............................19 .............................22 .............................22 ...................................25 .................................30 .............................30 .................................35 ..................................................37 .....................................43 .......................................43 .......................................45 .................................46 ..............................................47 ..................................................59 Abbasi, S. 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Exploring Characteristics of Hospital visits among Nurses in Taiwan
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Department of Nursing 96 1 97
() T2693408
2008-01-03 74 -
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Nurses Hospitalization Nurses National Health Insurance Research Database Hospitalization National Health Insurance Research Database
199720051997200599,84223,54723.6%99.58%28.66.137.88%4.11.737.84% 22,098.192,135 19972005919,245102,1384.31237 Present studies associated with the health issues of nurses in Taiwan focus largely on individual diseases, while hospitalization characteristics of nurses are poorly studied. Hence, this study is aimed at providing an insight into the hospitalization characteristics of nurses. This study used descriptive research design, file streaming was performed with data on “Inpatient expenditures by admissions” from the National Health Insurance Research Database for 1997 to 2005 and data on “Registered Nursing Practitioners” from the “Registry for medical personnel”. After file streaming, it was found that there were 23,547 nurses associated with hospitalization service among the 99,842 registered nursing practitioners from 1997 through 2005, leading to a hospitalization rate of 23.6%. Later, statistical analysis was performed with such variables as gender, age, years of work experience, employing agency, days of hospitalization, number of times of hospitalization, medical care type, diagnosis and expense. As to the results achieved in this study, we found that the female nurses had a hospitalization rate of 99.58%, an average hospitalization age of 28.6, an average work experience of 6.1 years, an average number of times of hospitalization of 1.7, and that a majority 37.88% of the female nurses were employed by a district hospital, a majority 37.84% of them were served by a district hospital and a majority of them were hospitalized gynecological reasons. As to diagnosis, early or threatened labor was most frequently seen in addition to normal delivery. As far as systematic diagnosis is concerned, gestagenic and puerperal complications, trauma and poisoning, urogenital diseases, respiratory diseases, digestive diseases, cancer diseases, musculoskeletal and connective tissue diseases ranked among top 7. On an average basis, NT$22,098.1 was spent per time of hospitalization resulting in an aggregate expense on hospitalization of NT$ 0. 92135 billion, and gestagenic and puerperal complications incurred the largest amount of hospitalization expense. As far as the effect of hospitalization cost on manpower cost is concerned, 919,245 nursing work days were spent from 1997 through 2005 due to hospitalization of nurses with an annual cost of 102,138 nursing work days. On average, each hospitalized nurses took 4.3 days off, which meat that a manpower cost of NT$ 0.1237 billion was incurred annually in economic terms due to hospitalization of nurses. Therefore it is suggested that nursing supervisors have a nearest nursing facility serve the pregnant nurses to avoid staying on their feet for long hours and fatigue due to frequent traveling between work site and nursing facility. A manpower assistance network should be established to reinforce manpower when pregnant nurses are off. In performing work design, nursing supervisor should take workflow fluency and facility integrity into consideration, for example, they could meliorate the vehicle in which a pregnant nurse works to enable the vehicle to hold a drinking container easily, while the schedule could be designed on a two-hour-session basis to allow the nurses a chance to go to the restroom. It’s also suggested that the nursing professions include a mammography in their regular physical check-up and that work shift be substituted with monthly permanent shift to have nursing professions coordinate their regular physical check-up with shift and enhance the flexibility of physical check Last of all, it’s suggested that clinic nurses wear knee shields to provide protection when bending their knees and that electric bed should be given priority over manual bed to reduce nursing bending moves for nursing professionals. I III V VI VIII IX 1 1 3 3 4 4 6 8 8 9 10 11 11 13 14 14 15 16 16 17 21 22 22 27 32 52 56 56 57 59 64 65 66 66 67 69 69 71
19972005 25 19972005 26 19972005 30 19972005 31 19972005 39 19972005 39 19972005 40 19972005 41 19972005 42 19972005 43 19972005_1 54 19972005_2 54 19972005 55
14 20 45 46 46 47 47 49 50 50 51 51
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48 48 49
20052006710http://www.doh.gov.tw
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The Relationship among Ethical Climate Types, Facets of Job Satisfaction, the Three Components of Organizational Commitment, and Organizational Citizenship Behavior Types- A Study of Nurses in Taiwan
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Department of Business Administration 96 1 97
() r4891110
2008-01-30 131 -
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ethical climate organizational citizenship behaviors three components of organizational commitment job satisfaction nurses
SEM()310 The high turnover of nurses has become a global problem. Several studies have proposed that nurses’ perceptions of the ethical climate of their organization are related to higher job satisfaction, organizational commitment, and organizational citizenship behaviors, and thus lead to lower turnover. However, there is limited empirical evidence supporting a relationship among different types of ethical climate within organizations, facets of job satisfaction, the three components of organizational commitment, and organizational citizenship behavior types. This study attempts to explore the different types of ethical climate that exist in hospitals, and the degree of job satisfaction, organizational commitment, and organizational citizenship behaviors of nurses in Taiwan. It uses SEM to understand the relationship among overall ethical climate, overall job satisfaction, overall organizational commitment, and overall organizational citizenship behaviors. The study uses hierarchical multiple regression to examine the relationship between ethical climate and facets of job satisfaction. It also examines the impact of different types of ethical climate and facets of job satisfaction on the three components of organizational commitment, and the impact of different types of ethical climate, facets of job satisfaction, and the three components of organizational commitment on three types of organizational citizenship behaviors. Questionnaires were distributed to 310 nurses. The relationships among variables were assessed by confirmatory factor analysis (CFA), reliability, descriptive statistics, correlations, oneway ANOVA, SEM, and hierarchical multiple regression. The important conclusion is that hospitals can increase job satisfaction, organizational commitment, and organizational citizenship behaviors by influencing an organization’s ethical climate. Hospital administrators can foster within organizations the climate types of caring, independent, and rules climate that increase satisfaction, while preventing organizations from developing the type of instrumental climate that decreases it. Furthermore, hospital administrators can foster the satisfaction of supervisors, co-workers, and work itself that increases affective and normative commitment. Finally, hospital administrators can foster affective and normative commitment that increase three types of organizational citizenship behaviors, and decrease continuous commitment.
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KNOWLEDGE ABOUT WOUND MANAGEMENT AMONG HOSPITAL NURSES IN INDONESIA
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Department of Nursing 104 2 105
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2016-07-25 84 ()
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wound management knowledge nurses TIME framework
none Background: The wound care knowledge is updated. Nurse need to have new evidenced knowledge to improve quality of care. Compared to community nurses, nurses in hospital had poor wound care knowledge. Limitted studies examined the level of knowledge among hospital nures in the context of wound management. Aims and objectives: The purpose of this study is to describe the self-reported knowledge about wound management among hospital nurses in Indonesia. Two aims in this study included (1) to understand the level of knowledge about wound management among hospital nurses (2) to identify factors that may influence nurses’ knowledge about wound management. Design: Descriptive cross-sectional survey design. Methods: A convenience sample of 181 nurses working in Pekalongan regency, Central Java, Indonesia. Nurses who work in ICU, ED, Pediatric, Surgical, and Medical ward invited to complete a 28-item questionnaire developed by Ayello & Baranoki (2014) which contained 20 questions of knowledge of wound management and 8 questions contained nurses’ perception of wound care in the facility. Result: There were 181 nurses participated in this study. The level of knowledge among hospital nurses in this study was poor. By the average nurses in this study were able to answer 10.3 questions overall (51.5%). Gender and Education level were not influenced nurses’ knowledge in this study, while research experience and training were influenced nurses’ knowledge almost in all aspects. A multiple linear regression model has significantly explained the level of knowledge of overall wound management by 6%. The wound education training may be able to increase nurses’ knowledge of wound management ( = 0.21, p < 0.05) compared to nurses who never got any training. Meanwhile, the research experience may decrease nurses’ knowledge of wound management ( = -0.26, p < 0.01). In terms of TIME framework, surgical and Emergency nurses tend to have better knowledge related to tissue management and moisture balance but poor in the domain of epithelial advancement. Conclusion: This study revealed the current level of knowledge of wound management among hospital nurses in Indonesia is poor. Continuing providing wound care education is recommended in order to improve nurses’ knowledge and reflects the clinical practices in wound management. ABSTRACT II TABLE OF CONTENT III LIST OF TABLE VI LIST OF FIGURE VII LIST OF APPENDIX VIII CHAPTER ONE 1 1.1. Research Background. 1 1.2. Research Purpose 5 1.3. Research Framework 5 CHAPTER TWO 6 2.1. General concepts of wounds 6 2.2. General principles of wound management 8 2.2.1. Tissue Management 9 2.2.2. Inflammation and infection control 11 2.2.3. Moisture balance 13 2.2.4. Epithelial (edge) advancement 14 2.3. Factors influencing wound healing 15 2.4. Nurse’s knowledge about wound management 15 2.5. Factors that may influence nurses’ knowledge about wound management 19 2.6. Instrument to measure level of knowledge in wound management 22 CHAPTER THREE 24 3.1. Design and Sampling 24 3.1.1. Design 24 3.1.2. Sample 24 3.2. Research Instrument 25 3.3. The wound management questionnaire 26 3.4. The Role of Nurses in Wound Care in Indonesia 27 3.5. Ethical Consideration 28 3.6. Data Collection 28 3.7. Research data analysis 29 CHAPTER FOUR 30 4.1. Hospital Nurses Characteristic 30 4.2. Nurses’ Knowledge about Wound Management 33 4.3. Nurses’ Perception and the Condition of Wound Care 34 4.4. Factors which correlated to Nurses’ knowledge 36 4.4.1. Knowledge of tissue management and moisture balance 38 4.4.2. Knowledge of infection control 39 4.4.3. Knowledge of epithelial advancement 39 4.4.4. Knowledge of wound assessment 40 4.4.5. Knowledge of acute wound 41 4.4.6. Overall knowledge of wound management 42 CHAPTER FIVE 43 5.1. Discussion 43 5.1.1. Knowledge of wound management among hospital nurses 43 5.1.2. Factors related to wound care knowledge 45 5.1.3. Knowledge of wound management related to the TIME framework 48 5.1.4. Nurses’ Perception and the condition of wound care in the facility 51 5.2. Limitation 52 5.3. Implication in nursing field 53 5.4. Future research 55 5.5. Conclusions 55 REFERENCES 57 Abdelrahman, T., & Newton, H. (2011). Wound dressings: principles and practice. Surgery (Oxford), 29(10), 491-495. doi: http://dx.doi.org/10.1016/j.mpsur.2011.06.007 Allegranzi, B., & Pittet, D. (2007). Healthcare-associated infection in developing countries: simple solutions to meet complex challenges. Infection control hospital Epidemiology, 28(12), 1323-1327. doi: 10.1086/521656 Australian Wound Management Association (2010) Standards for Wound Management. Cambridge Publishing, West Leederville, WA, p. 5. Ayello, E. A., & Baranoski, S. 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Knowledge, Attitude and Behavior Related To Healthcare-Associated Infections of Nurses Working in Emergency Department In Indonesia
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Department of Nursing 103 2 104
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2015-07-24 72 ()
none
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nurses knowledge attitude behavior healthcare-associated infections
none Healthcare Associated Infections (HAIs) are considered as being among the most serious patient safety issues in health care settings. Especially in the Emergency Department (ED), nurses face greater risk of exposure to infectious pathogens. ED nurses’ daily intervention often involve contact with patients’ blood and/or other body fluids. To protect ED nurses from infectious agents, standard precautions are essential and also effective in reducing the number of HAIs. However, knowledge, attitude, behavior towards HAIs and relationships between these three variables among nurses working in EDs in developing countries such as Indonesia, has not yet been studied. Therefore, it is imperative to explore the knowledge, attitude, behavior towards HAIs and their relationships, among nurses working in EDs in Indonesia. In addition, the influence of demographic characteristics on nurses’ knowledge, attitude, and behavior were examined in this study. A cross-sectional, self-reported survey was conducted and a total of 115 participants were recruited from four hospitals in Bandung City, Indonesia. The Healthcare Associated Infections Survey (HAIS) consisting of four domains: demographic characteristics, knowledge, attitude and behavior related to HAIs was used for the survey. ED nurses’ overall performance on the knowledge portion was good, with a mean of 21.23±5.173 (range=9-30). They produced better scores on control measures and risk factors for HAIs, but did poorly on some questions about HAI source pathogens. 92.2% had positive attitudes and the mean score for behavior when practicing infection control was 37.7±5.570 (26-50). Marital status (Z = -2.838, p = 0.005) and working hours per week, influenced nurses’ knowledge of HAIs (rs = 0.185, p = 0.048). Work experience was found to have a negative relationship towards attitude (rs = -0.196, p = 0.035). While, type of hospital (F (113) = 5.560, p = 0.005) and working hours per week (r = 0.191, p = 0.04) influenced behavior. However, no significant relationship was found between knowledge, attitude and behavior towards HAIs. Even though the majority of ED nurses in Indonesia believe that precautionary guidelines can reduce the risk of HAIs, in fact most nurses’ behavior was sub-optimal. Therefore, it is essential for healthcare institutions to conduct surveillance, monitor good behavior of infection control practices and provide continuous education for ED nurses. Furthermore, healthcare managers should consider nurses’ characteristics when developing an education plan. ABSTRACT I TABLE OF CONTENTS III LIST OF TABLES V CHAPTER ONE INTRODUCTION 1 1.1 Research Background. 1 1.2 Significance of Study 3 1.3 Study Purposes 3 1.4 Operational Definitions 4 1.4.1 Knowledge 4 1.4.2 Attitude 4 1.4.3 Behavior 4 CHAPTER TWO LITERATURE REVIEW 5 2.1 Healthcare-associated infections 5 2.1.1 Sources of Healthcare-Associated Infections 7 2.1.2 Prevention of Healthcare-Associated Infections 9 2.2 Risk of infections for emergency department nurses 10 2.3 Relationship of healthcare-associated infections and nurses' knowledge, attitude and behavior 14 CHAPTER THREE RESEARCH DESIGN AND METHODOLOGY 17 3.1 Research Design 17 3.2 Sample and Setting 17 3.3 Instrument 17 3.3.1 Demographic Questionnaire 19 3.3.2 Knowledge about HAIs 19 3.3.3 Attitudes toward HAIs 19 3.3.4 Behavior toward standard precautions 19 3.4 Data collection procedures 20 3.5 Statistical analysis 20 CHAPTER FOUR RESEARCH RESULTS 22 4.1 Demographic and characteristics of participants 22 4.2 Knowledge, attitude, and behavior 23 4.3 Influence of demographic characteristics of nurses on their knowledge, attitude and behavior of HAIs 27 4.4 Relationship of nurses’ knowledge, attitudes and behavior toward HAIs 28 CHAPTER FIVE DISCUSSION 30 5.1 Demographic and occupational characteristics 30 5.2 Nurses’ knowledge, attitude, and behavior toward HAIs 32 CHAPTER SIX CONCLUSION AND RECOMMENDATION 35 6.1 Conclusion 35 6.2 Recommendations 36 6.3 Limitation 37 REFERENCES 38 APPENDICES 59 Appendix 1 IRB Approval 59 Appendix 2 Permission to use HAIs Survey Instrument 60 Appendix 3 Informed Consent (English Version) 61 Appendix 4 Inform Consent (Indonesia Version) 62 Appendix 5 Research Instrument (English Version) 64 Appendix 6 Research Instrument (Indonesia Version) 68 LIST OF TABLES Table 4.1 Demographic and occupational characteristics of respondents 22 Table 4.2 Test of normality on variables 23 Table 4.3 Total score of knowledge, attitude and behavior of HAIs 24 Table 4.4 Proportion of correct answers of knowledge of HAIs by nurses 25 Table 4.5 Nurses’ behavior related to HAI 26 Table 4.6 Differences of ED nurses’ knowledge, attitudes and behavior by the demographic and occupational characteristics 27 Table 4.7 Correlation between continuous variables of demographic and occupational characteristics and ED nurses’ knowledge, attitudes and behavior 28 Table 4.8 Relationship of nurses’ knowledge, attitudes and behavior 29 Affonso, D. 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Factors Related to Workplace Violence against Nurses in Indonesian Emergency Departments
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Department of Nursing 102 2 103
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2014-07-09 85 - - ()
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emergency department factors Indonesia nurses workplace violence
none Objective: The objective of this study is to examine violent incidents experienced by nurses and the associated factors of violence against nurses in Indonesian emergency departments. Methods: A structured questionnaire from the World Health Organization (WHO) on workplace violence in the health sector was modified and translated into Bahasa. A total of 169 nurses working in emergency departments in six (6) hospitals in Jakarta and Bekasi Indonesia were participated in the study. The gathered data were analyzed using descriptive and multivariate logistic regression. Result: Ten percent of emergency nurses reported experiencing physical violence and mainly perpetrated by patients, whereas more than a half of emergency nurses (54.6 %) reported experiencing non-physical violence with patient’s relative as the main perpetrators. More than of nurses (55.6%) did not have encouragement to report workplace violence and very few (10.1%) of nurses had received any information or training about workplace violence. No predictors were found to be associated with physical violence, whereas the predictor for nonphysical violence is type of hospitals. Conclusion: The findings of this study highlighted the seriousness of violence in Indonesian emergency departments. Support from the management, encouragement to report violence and availability of workplace violence training are expected to mitigate and manage violence against nurses in emergency departments. Acknowledgements ii Abstract iv Table of Contents v List of Tables ix Chapter I. Introduction Background 1 Research Purpose 4 Definition of Terms 5 Overview of Methodology 6 Research design 6 Sample 6 Measurement 6 Analysis 7 Significance 7 Chapter II. Literature Review Definition of Workplace Violence 8 Workplace Violence in Health Care Settings 9 Workplace violence in general health care settings 9 Workplace violence in emergency departments 9 Workplace Violence in against Nurses 10 Workplace violence against nurses in general 10 Workplace violence against nurses in emergency departments 10 Workplace violence against nurses in Indonesia 11 The Impact of Workplace Violence 12 Impact to nurses 12 Impact to nurses’ personal lives 12 Impact to nurses’ professional lives 13 Impact to patients 14 Factors Related to Workplace Violence 14 Perpetrators 14 Nurses’ personal characteristics 15 Age 15 Marital status 16 Gender 16 Level of anxiety 16 Ethnicity 17 Level of education 17 Nurses’ professional characteristics 18 Violence training 18 Year of experiences 18 Previous violence experience 18 Environment 19 Employment sector 19 Shift work 19 Presence of violence preventive measures 19 Chapter III. Method Research Design and Sampling 21 Measurement 22 Modified version 24 Ethical Considerations 25 Data Collection Procedures 26 Analysis 27 Chapter IV. Research Results Personal and Workplace Characteristics 28 Magnitude and Characteristic of Workplace Violence 31 Frequency of violent incidents 31 Emergency nurses’ responses to violent incidents 33 Problems or complaints after violent incidents 34 Actions after the violent incidents 35 Safety measures in the workplace 37 Factors and Predictor for Workplace Violence 40 Related factors for workplace violence 40 Predictors to workplace violence 44 Qualitative Survey 44 Chapter V. Discussion Discussion 46 Limitation of the Study 52 Future Study Recommendation 52 Implication 52 Conclusion 53 References 54 Appendix 1: Informed Consent 59 Appendix 2: Questionnaire 62 Appendix 3: Content Validity Index 75 Appendix 4: Questionnaire Permission 77 Appendix 5: Ethical Clearance 79 Appendix 6: Hospital Permission 80 Boyle, M., Koritsas, S., Coles, J., Stanley. J. (2007). A pilot study of workplace violence towards paramedics. Emergency Medicine Journal, 24, 760–763. Campbell, et al. (2011). Workplace Violence: Prevalence and Risk Factors in the Safe at Work Study. Journal of Occupational and Environmental medicine,53, 1, 82-89. doi: 10.1097/JOM.0b013e3182028d55 Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 1, 155-159. Cooper, C.L., & Swanson, N. (n.d). Workplace violence in the health sector. Retrieved from http://www.who.int/violence_injury_prevention/injury/en/WVstateart.pdf Esmaeilpour, M., Salsali, M., Ahmadi, F. (2010). Workplace Violence Against Iranian Nurses Working in Emergency Departments. International Nursing Review, 58, 130-137. Fathoni, M., Sangchan, H., Songwathana, P. (2013). Relationships between Triage Knowledge, Training, Working Experiences and Triage Skills among Emergency Nurses in East Java, Indonesia. Nurse Media Journal of Nursing, 3, 1, 511- 525. Fujishiro, K., Gee, G.C., de Castro, A.B. (2011). Associations of workplace aggression with work-related well-being among nurses in the Philippines. American Journal of Public Health, 101 (5), 861-867. Gacki-Smith, J., Juarez, A.M., Boyett, L.. (2009). Violence Against Nurses Working in US Emergency Departments. Journal of Nursing Administration, 39 (7/8), 340-349
Gates, D., Gillespie, G., Kowalenko, T., Succop, P., Sanker, M., Farra, S. (2011). Occupational and demographic factors associated with violence in the emergency department. Advanced Emergency Nursing Journal, 33 (4), 303-313. doi: 10.1097/TME.0b013e3182330530 Gates, D.M., Gillespie, G.L., & Succop, P. (2011). Violence Against Nurses and its Impact on Stress and Productivity. Nursing Economics, 29, 59-67 Gillespie, G.L., Gates, D.M., Miller, M., Howard, P.K. (2010). Workplace violence in healthcare settings: Risk factors and protective strategies. Rehabilitation Nursing, 35 (5),177-184 Hahn, S., Müller, M., Hantikainen, V., Kok, G., Dassen, T., Halfens, R.J.G. (2013). Risk factors associated with patient and visitor violence in general hospitals: Results of a multiple regression analysis. International Journal of Nursing Studies, 50, 374–385. doi: 10.1016/j.ijnurstu.2012.09.018 ILO/ICN/WHO/PSI. (2002). Framework Guidelines for Addressing Workplace Violence in the Health Sector. ILO/ICN/WHO/PSI Joint Programme onWorkplace Violence in the Health Sector, Geneva. ILO/ICN/WHO/PSI. (2003). Workplace Violence in the Health Sector: Country Case Studies Research Instruments Survey Questionnaire (English). ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health Sector, Geneva. Keitha, D. (2013, June 22). Kronologis Penganiayaan Perawat oleh Dokter Orthopedi di RS DKT Lampung [Web blog post]. Retrieved from http://blogperawat.com/ Khusnizar. (2013, February 28). Sidang Kasus Penganiayaan Perawat RSUD Abdul Manap, Abu Hanifah Bantah Semua Keterangan Saksi. Metrojambi.com. Retrieved from http://www.metrojambi.com/ Landis, J.R. & Koch, G.G. (1977). The Measurement of Observer Agreement for Categorical Data. International Biometric Society, 33(1), 159-174. Lanza, M.L., Zeiss, R.A., Rierdan, J. (2006). Non-Physical Violence, A risk Factor for physical violence in Health Care settings. AAOHN Journal, 54(9), 397- 402. Lin, Y. & Liu, H. (2005). The impact of workplace violence on nurses in South Taiwan. International Journal of Nursing Studies 42, 773–778. doi: 10.1016/j.ijnurstu.2004.11.010 Luck, L., Jackson, D., Usher, K. (2006). Innocent or culpable? Meanings that emergency department nurses ascribe to individual acts of violence. Journal of Clinical Nursing 17 , 1071– 1078. doi: 10.1111/j.1365-2702.2006.01870.x Magnavita, N & Heponiemi, T. (2011). Workplace Violence Against Nursing Students and Nurses: An Italian Experience. Journal of Nursing Scholarship, 43:2, 203–210. doi: 10.1111/j.1547-5069.2011.01392.x National Advisory Council on Nurse Education and Practice (NACNEP). (2007). Violence Against Nurses: An Assessment of the Causes and Impacts of violence in Nursing Education and Practice. Occupational Safety and Health Administration (OSHA). (2004). Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. Pai, H., & Lee, S. (2011). Risk factors for workplace violence in clinical registered nurses in Taiwan. Journal of Clinical Nursing, 20, 1405–1412. doi: 10.1111/j.13652702.2010.03650.x Pinar, R. & Ucmak, F. (2010). Verbal and physical violence in emergency departments: a survey of nurses in Istanbul, Turkey. Journal of Clinical Nursing, 20, 510–517. doi: 10.1111/j.1365-2702.2010.03520.x Polisi Diminta Usut Penganiayaan Perawat. (2013, March 27). Retrieved from http://rakyataceh.com/index.php Polit, D.F., & Beck, C.T. (2006). The content validity index: Are you sure you know what’s being reported? Critique and recommendations. Research in Nursing & Health, 29, 489-497. doi: 10.1002/nur.20147 Roche, M., Dier, D., Duffield, C., Catling-Paull, C. (2010). Violence Toward Nurses, the Work Environment, and Patient Outcomes. Journal of Nursing Scholarship, 42:1, 13–22. doi: 10.1111/j.1547-5069.2009.01321.x Stanhope, M. & Lancaster, J. (2011). Public health nursing: Population-centered health care in the community. (8th ed.). St. Louis, MA: Mosby. Suryadinata, L., Arifin, E.N., Ananta, A. (2003). Indonesia's Population: Ethnicity and Religion in a Changing Political Landscape. Singapore: Institute of Southeast Asian Studies. Talas, M.S., Kocaöz, S., Akgüç, S., (2011). A survey of violence against staff working in the emergency department in Ankara, Turkey. Asian Nursing Research, 5, 197-203. doi:10.1016/j.anr.2011.11.0 01 Taylor, J.L. & Rew, L. (2010). A systematic review of the literature: workplace violence in the emergency department. Journal of Clinical Nursing, 20, 1072-1085. doi:10.1111/j.13652702.2010.03342.x
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The predictors of self-reported actual and intended physical activity among hospital nurses
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Department of Nursing 100 1 101
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2012-01-12 105 -
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Nurses Physical activity Theory of planned behavior Perceived work-site support
469Ajzen47.3%(OR=1.52, 95% CI=1.15-2.01)(OR=1.34, 95% CI=1.07-1.67)44.4%5.9% Purpose: The aims of this study were to assess the patterns of physical activity and monthly regular exercise among hospital nurses, and to identify the related cognitive factors to predict their levels of moderate or vigorous physical activity. In addition, we also investigated whether the nurses perceived their work-site environment as being supportive to the promotion of physical activity. Method: A cross-sectional design was used in this study. Participants were recruited from the medical center hospital and regional hospital in southern Taiwan. Stratified sampling was used based on the work-site units’ characteristics, including the number of nurses in each unit, and included 469 female nurses. Physical activity (PA) in the past seven days was measured using the International Physical Activity Questionnaire (IPAQ). We adopted the theory of planned behavior (TPB), as developed by Ajzen, to frame the related factors to determine the PA levels of moderate and above. In addition, the Perceptions of the Workplace Environment Scale (PWES) was used to assess the nurses’ perceptions of how much support was given in the workplace environment to promote their PA. Hierarchical logistic regression was applied to examine the determinants of undertaking PA at the levels of moderate and above. Furthermore, hierarchical multiple regressions were used to analyze the predictors of intention to engage in physical activity, which included related factors, perceived behavioral control, attitude and subjective norm. Results: The results show that 47.3% of the participants had engaged in moderate or vigorous physical activity in the previous seven days. Higher levels of intention and having more children compared with having less intention and fewer children were associated with more PA. The odd’s ratios were 1.52 (95% CI=1.15-2.01) and 1.34 (95% CI=1.07-1.67), respectively. Moreover, perceived behavioral control, attitude and subjective norm were found to significantly predict the intention to engage in PA, with a variation of 44.4%. Only 5.9% of the respondents reported taking regular exercise in the past month, and the major reason given for irregular exercise was “laziness”. With regard to the Perceptions of the Workplace Environment, most of the nurses perceived that their work-site offered little support for PA at either the policy or organizational levels. Conclusion: The study found the rates of engagement in moderate or vigorous physical activity and regular exercise were low among hospital nurses. We suggest that the behavioral intention to undertake PA should be promoted first, and that work-site physical activity programs could combine parent-child activities. In particular, efforts should be focused on increasing nurses' perceived behavioral control, positive attitudes and subjective norm. 1 1 4 5 7 7 10 :16 22 29 29 31 35 41 43 45 45 54 66 70 70 74 82 88 91 (2011)19(2)223-232 ()9720111215http://www.sac.gov.tw/DownloadList/DownloadList.aspx?wmid=130 2010520110309http://www.bhp.doh.gov.tw (2011)-6249-67 (2009) (2000)–Polar Vantage NV1433-48 (2008)5(2)147-160 (2002)-RT3 Tri-axial171-14 (2009)4(1)119-137 (2008) (2009)10(2)93-110 (2006)-39(1)39-54 (2008)28367-384 (2006a)2(2)55-65. (2006b)59-19 (2003)266-84 (2006)5(1)7-30 (2003)-5(1)39-48 2002— (2004) (2009)- (1999) (2009) (2009) (2011)7(2)27-37 3(1)6-16 (2006) (2008)15(1)9-42 (2010)(65-80) (2009) (2009)17(3)371-384 (2009)119-34 (2004) (2007)(12.3-12.37) (2007)Journal of Nursing Research, 15(2), 138-146 (2008)~ (2009)- (2005)16(3)167-179 Ajzen, I. (1985). From intension to actions : a Theory of Planned Behavior. In J.kuhl, J. Beckman (Eds), Action control:From cognition to behavior (pp.11-39). Geidelberg:Springer. Ajzen, I. (1991). The Theory of Planned Behavior. Organizational behavior and human decision processes, 50, 179-211. Ajzen, I. (2000). Construction of a standard questionnaire for the theory of planned behavior. http://www.unix.oit.umass.edu/ ~aizen/. Retireved 11 Januranury 2011. Ajzen, I. (2002). Perceived behavioral control, self-efficacy, locus of control, and the Theory of Planned Behavior. Journal of Social Psychology, 32, 665-683. Bamuman, A. E., Sallis, J. F., Dzewaltowski, D. A., Owen, N. (2002). Toward a better understanding of the influence on physical activity. American Journal of Medicine, 23(25), 5-14. Bauman, A. E., Sallis, J. F., Dzewaltowski, D. A., Owen, N. (2002).Toward a Better Understanding of the Influences on Physical Activity The Role of Determinants, Correlates, Causal Variables, Mediators, Moderators, and Confounders. American Journal of Preventive Medicine, 23(2S),5–14. Biddle, S. Goudas, M. (1994). Social-psychological predictors of self-reported actual and intended physical activity in a university workforce sample. British journal of sport medicine, 28(3), 160-163. Blue, C. L., Wilbur, J. Marston-Scott, M. V. (2001).Exercise Among Blue-Collar Workers: Application of the Theory of Planned Behavior. Research IN Nursing and Health, 24, 481493. Booth, M. L., Owen ,N., Bauman, A. Clavisi, O., Leslie, E. (2000).Social–Cognitive and Perceived Environment Influences Associated with Physical Activity in Older Australians. Preventive Medicine, 31,15–22. Bouchard, C., Tremblay, A., Leblanc, C., Lortie, G., Savard, R. Theriault, G. (1983). A method to assess energy expenditure in children and adults. The American Journal of Clinical Nutrition, 37, 461-467. Boutelle, K., Murray, D. M. Jeffery, R. W. Herrikus, D. J Lando, H. A. (2000). Associations between exercise and health behaviors in a community sample of working adults, Preventive Medicine, 30, 217-224. Bozionelos, G., and Bennett, P. (1999). The theory of planned behavior as predictor of exercise: the moderating influence of beliefs and personality variables. Journal of Health Psychology, 4(4),517–529. Burton, N. W. Turrell, G. (2000). Occupation, Hours Worked, and Leisure-Time Physical Activity. Preventive Medicine, 31, 673-681. Cabab-Martinez, Lee, A. J., D. J., Flemin, L. E., LeBlanc, W. G., Arheart, K. L., Chung-Bridges, K. et al.(2007). Leisure-time physical activity level of the US workforce, Preventive Medicine, 44, 432-436. Carig, C. L., Marshall, A. L., Sjostrom, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., et al., (2003). International Physical Activity Questionnaire: 12-Country Reliability and Validity. Medicine & Science in Sports & Exercise, 35(8), 1381-1395. Caspersen, C. J., Powell, K. E. Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: Definitions and distinctions for health related research. Public health reports, 100, 126-130. Chee, H. L., Kandiah, M., Khalid, M., Shamsuddin, K., Jamaluddin, J. Megat, N. A. et al., (2004). Body mass index and factors related to overweight among women workers in electronic factories in Peninsular Malaysia. Asia Pacific Journal of Clinical Nutrition, 13(3), 248-254. Chi, L. Hsu, C. C.(2005). The prediction of regular exercise intention and behavior among elementary school teachers- a test the theory of planned behavior. Bulletin of Sport and Exercise Psychology of Taiwan, 7, 115-129. Damush, T. M., Stewart, A. L., Mills, K. M., King, A. C., Ritter, P. L. (1999). Prevalence and correlates of physician recommendations to exercise among older adults, Journal of Gerontology. Series A, Biological Sciences and Medical Sciences, 54(8), 423-427. Dodson, E.A., Lovergreen, S.L., Elliott, M.B., Haire-Johu, D. Brownson, R.C.(2007). Worksite policies and environments supporting physical activity in Midwestern Communities. American Journal of Health Promotion, 23(1), 51-55. Downs, D. S. Hausenblas, H. A. (2005). The theories of reasoned action and planned behavior applied to exercise: a meta-analytic update. Journal of Physical and Health, 2, 76-97. Fishbein, M., & Ajzen, I. (1975). Attitude, Intention and Behavior. Don Mills,New YorkAddison-Wesley. Garcia, A. W. King, A. C. (1991). Prediction long term adherence to aerobic exercise: A comparison of two models, Journal of Sport Exercise Psychological, 13(4), 394-410. Godin, G. Shephard, R. J. (1985). A simple method to assess exercise behavior in the community. Canadian Journal of Applied Sport Sciences, 10(3), 141-146. Godin, G. (1994). Theories of reasoned action and planned behavior: usefulness for exercise promotion, Medicine and Science in Sports and Exercise, 26, 141-146. Godin, G., Amireault, S., Belanger-Gravel, A., Vohl, M. C. Perusse, L. (2009). Prediction of Leisure-time Physical Activity Among Obese Individuals. Obesity, 17, 706-712. Haskell, W. L., Lee, I. M., Pate, R.R., Powell, K. E., Blair, S.N., Franklin, B.A., Macera, C.A., et al. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1081-93. International Physical Activity Questionnaire(n.d.).Downloadable questionnaires. Retrieved January 9, 2011, form http://www.ipaq.ki.se/ipaq.htm. Jaffee, M., Lutter, J.M., Rex, J., Hawkes, C. Bucaccio, T.B. (1999). Incetives and Barriers to Physcial Activity for Working Women. American Journal of Health Promotion, 13(4), 215218. Johnson, C. A., Corrigan, S. A., Dubbert, P. M., Gramling, S. E. (1990). Perceived barriers to exercise and weight control practices in community women, Women Health, 16(3 & 4), 177-191. Jones, P. S., Lee, J. W., Phillips, L. R., Zhang, X. E., & Jaceldo, K. B. (2001). An adaptation of Brislin’s translation model for cross-cultural research. Nursing Research, 50(5), 300-304. Kimiecik, J. (1992). Predicting vigorous physical activity of corporate employees: comparing the theories of reasoned action and planned behavior, Journal of Sports Exercise Psychology, 14, 192-206. King, A. C., Castro, C., Wilcox S., Eyler, A. A., Sallis, J. F. (2000). Personal and Environmental Factors Associated With Physical Inactivity Among Different Racial-Ethnic Groups of U.S. Middle-Aged and Older-Aged Women. Health Psychology, 19(4), 354-364. King, A. C., Castro, C., Wilcox S., Eyler, A. A., Sallis, J. F. (2000). Personal and Environmental Factors Associated With Physical Inactivity Among Different Racial-Ethnic Groups of U.S. Middle-Aged and Older-Aged Women. Health Psychology, 19(4), 354-364. LaPorte R. E., Montoye H. J., & Caspersen C. J. (1985). Assessment of physical activity in epidemiologic research: problems and prospects. Public Health Reports, 100(2), 131-46. Lemon, S. C., Zapka, J., Li, W., Estabrook, B., Magner, R., Rosal, M.C.(2009) Perceptions of Worksite Support and Employee Obesity, Activity and Diet. American Journal of Health Behavior, 33(3), 299-308. Lian, W. M., Gan, G. L., Pin, C. H., Ye, H. C. (1999). Correlates of leisure-time physical activity in an elderly population in Singapore, Journal of Public Health, 89, 1578-1580. Lucove, J., Huston, S.L. Evenson, K.R. (2006). Workers’perception about worksite policies and environments and their association with leisure-time physical activity. American Journal of Health Promotion, 21(3), 196-200. Matthew, S. K. Grossman, A. H. (1998). Attitudinal, social, and practical correlates to fitness behavior: a test of the theory of planned behavior. Perceptual and Motor Skills, 87(3), 1139-1154. Pate, R. R., Pratt M. S., Blair, S. N., William, L. H. Macera. C. A., Bouchard, C., et al. (1995) Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. Journal of American Medicine Association, 273(5), 402–407. Persson, M. Martensson, J. (2006). Situations influencing habits in diet and exercise among nurses working night shift. Journal of Nursing Management, 14, 414-423. Piazza, J. Conrad, K. Wiblur, J. (2001). Exercise behavior among female occupational health nurse. Official Journal of the American Association of Occupational Health Nurses, 49(2), 79-87. Plotnikoff, R. C., Prodaniuk, T. R., Milton, L. (2005). Development of an ecological assessment tool for a workplace physical activity program standard. Health Promotion Practice, 6(4), 453-463. Prodaniuk, T. R., Plotnikoff, R. C., Spence, J. C. Wilson, P. M. (2004). The influence of self-efficacy and outcome expectations on the relationship between perceived environment and physical activity in the work place. International journal of behavioral nutrition and physical activity, 1(7), doi:10.1186/1479-5868-1-7. Rhodes, R. E., Courneya, K. S. (2003).Investigating multiple components of attitude, subjective norm, and perceived control: An examination of the theory of planned behavior in the exercise domain. British Journal of Social Psychology, 42, 129-146. Rrespo, N.C., Sallis, J.F., Conway, T.L., Saelens, B.E., Frank, L.D., (2011).Worksite physical activity policies and environments in relation to employee physical activity. American Journal of Health Promotion, 25(4), 264-271. Sallis, J. F. Owen, N (1999). Physically activity and behavioral medicine(pp.111-139). Thousand OAKS, CA:Sage. Sallis, J. F., Johnson, M. F., Calfas, K. J. Caparosa, S., Nichols, J. F. (1997). Assessing perceived physical environmental variables that may influence physical activity. Research Quarterly for Exercise and Sport, 68(4),345-361. Sallis, J. F., Owen, N. Fisher, B. E. (2008).Ecological models of health behavior. In K. Glanz, B.k., Rimer K. Viswanath (Eds.), Health behavior and health education(4th ed., pp.465485). San Francisco , CA :Jossey-Bass. Sarkin, J., Campbell, J., Gross, L., Roby, J., Bazzo, S., Sallis, J., et al. (1997). Project GRAD seven-day physical activity recall interviewer's manual. Medicine and Science in Sports and Exercise, 29(6), 91-102. Schneider, S. Becker, S. (2005).Prevalence of Physical Activity among the Working Population and Correlation with Work-Related Factors: Results from the First German National Health Survey. Journal of Occupation Health, 47, 414-423. Steinhardt, M. A. Dishman, R. K. (1989). Reliability and validity of expected outcome and barriers for habitual physical activity, Journal of Occupational Medicine, 31(6), 536-546. Stephens, T. (1987). Secular trends in adults physical activity: exercise boom or bust? Research Quarterly for Exercise and Sport, 58, 94-105. Sternfed, B., Ainsworth, B. E., Quesenberry, C. P. (1999). Physical activity patterns in diverse population of women. Prevention Medicine, 28(3), 313-323. Thompson, W. R., Gordon, N. F., Pescatello, L. S. (2009). ACSM’s Guidelines for exercise testing and prescription(8th ed., pp. 7-9.). USA: Lippincott Williams and Wilkins. Trost, S. G., Owen, N. Bauman, A. E. Sallis, J. F., Brown, W. (2002) Correlates of adult’ participation in physical activity: review and update. Medicine Science in Sports Exercise, 34(12), 1996-2001. Vanhees, L., Lefevre, J., Philippaerts, R., Martens, M., Huygens, W., Troosters, T., et al. (2005).How to assess physical activity? How to assess physical fitness?. European Journal of Cardiovascular Prevention and Rehabilitation, 12( 2), 102-114. Zapka, J. M., Lemon, S. C., Magner, R. P., & Hale, J. (2009)Lifestyle behaviours and weight among hospital-based nurses. Journal of Nursing Management, 17, 853–860.
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Narratives of the ICU nurses caring for patients and families during the dying process
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Department of Nursing 98 2 99
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2010-07-22 61 -
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The ICU nurses dying process patients familie
10 The ICU nurses experience reluctance, emotional conflict and exhaustion due to the suffering of patients and their families during the dying process. This affects the quality of care and the health of the ICU nurses. The purpose of this study is to explore the experiences of the ICU nurses caring for patients and their families during the dying process and to help them define the meaning of these experiences. A narrative inquiry was conducted for ten ICU nurses in a southern Taiwan medical center. A semi-structure interview guide was used for collecting data during the interview. Results from this study show five main experiences: 1) “Seeing the suffering and feeling reluctant”- the ICU nurses saw the suffering of the patients and families during the aggressive treatment procedures. They feel reluctant and are moved to provide better care for the dying patients. 2) “Being there to accompany the dying, bringing peace and relief ” - the ICU nurses wish they can provide more emotional and spiritual care for the patients and families. 3) “Feeling conflict, struggle and exhaustion” - The ICU nurses felt emotional conflict, struggle, powerlessness and exhaustion during the caring process. 4) “Having a positive attitude and reorganizing life” - After the feeling of depression, self-reflection helped the ICU nurses change their attitudes and reorganize their lives. 5) “Getting support and looking to the future” - There was a lot of support from colleagues and relatives which helped the ICU nurses get power to look to the future. From presenting the stories of ICU nurses in context, their experiences can be heard, providing information for the improvement of education, administration and support systems in the future I Abstract II III IV VI 1 1 3 5 6 6 () 6 () 7 10 () 10 () 11 13 () 13 () 14 16 16 18 20 21 22 () 22 () 27 () 28 30 () 31 () 31 () 32 () 33 34 34 () 35 () 36 37 () 37 () 38 40 () 40 () 41 () 43 44 () 44 () 45 46 () 46 () 47 49 49 52 54 () 54 () 56 57 57 57 () 58 () 59 61 () 61 () 61 i vi viii ix
19 24 24 25 26 27 (20021211)20081015http://law.moj.gov.tw/Scripts/Query1A.asp?no=1L0020066&K1=&KeyWordID=&KCDate= 200918149-182 20046133-45 200552676-81 200861-80 2006194395-415 2004 3449-60 2005 1998- 2002 2007 20095615-10 2006-(3)133-164 Angus, D. C., Barnato, A. E., Linde-Zwirble, W. T., Weissfeld, L. A., Watson, R. S., Rickert, T., et al. (2004). Use of intensive care at the end of life in the United States: an epidemiologic study. Critical Care Medicine, 32(3), 638-643. Badger, J. M. (2005). Factors that enable or complicate end-of-life transitions in critical care. American Journal of Critical Care, 14(6), 513-522. Beckstrand, R. L., Callister, L. C., & Kirchhoff, K. T. (2006). Providing a "good death": critical care nurses' suggestions for improving end-of-life care. American Journal of Critical Care, 15(1), 38-46. Beckstrand, R. L., & Kirchhoff, K. T. (2005). Providing end-of-life care to patients: critical care nurses' perceived obstacles and supportive behaviors. American Journal of Critical Care, 14(5), 395-403. Beckstrand, R. L., Smith, M. D., Heaston, S., & Bond, A. E. (2008). Emergency nurses' perceptions of size, frequency, and magnitude of obstacles and supportive behaviors in end-of-life care. Jouranl of Emergency Nursing, 34(4), 290-300. Brosche, T. A. (2003). Death, dying, and the ICU nurse. Dimensions of Critical Care Nursing, 22(4), 173-179. Buauchamp, T. L., & Childress, J. F. (2009) Principles of biomedical ethics. New York: Oxford University press. Cambridge University Press. (2005). Cambridge advanced learner's dictionary. Cambridge: Cambridge University Press. Campbell, M. L. (2006). Palliative care consultation in the intensive care unit. Critical Care Medicine, 34(11), S355-358. Chen, Y. C., Lin, S. F., Liu, C. J., Jiang, D. D., Yang, P. C., & Chang, S. C. (2001). Risk factors for ICU mortality in critically ill patients. Journal of the Formosan Medical Association, 100(10), 656-661. Clarke, E. B., Curtis, J. R., Luce, J. M., Levy, M., Danis, M., Nelson, J., et al. (2003). Quality indicators for end-of-life care in the intensive care unit. Critical Care Medicine, 31(9), 22552262. Curtis, J. R., & Engelberg, R. A. (2006). Measuring success of interventions to improve the quality of end-of-life care in the intensive care unit. Critical Care Medicine, 34(11), S341347. Dunn, G. P., & Mosenthal, A. C. (2007). Palliative care in the surgical intensive care unit: where least expected, where most needed. Asian Journal of Surgery, 30(1), 1-5. Dunn, K. S., Otten, C., & Stephens, E. (2005). Nursing experience and the care of dying patients. Oncology Nursing Forum, 32(1), 97-104. Evans, M. J., & Hallett, C. E. (2007). Living with dying: a hermeneutic phenomenological study of the work of hospice nurses. Journal of Clinical Nursing, 16(4), 742-751. Esponosa, L.,Young, A., Symes, L., Haile, B., & Walsh, T. (2010). ICU nurses' experiences in providing terminal care. Critical Care Nursing Quarterly, 33(3), 273-281. Espinosa, L., Young, A., & Walsh, T. (2008). Barriers to intensive care unit nurses providing terminal care: an integrated literature review. Critical Care Nursing Quarterly, 31(1), 83-93. Gross, A. G. (2006). End-of-life care obstacles and facilitators in the critical care units of a community hospital. Journal of Hospice & Palliative Nursing, 8(2), 92-102. Halcomb, E., Daly, J., Jackson, D., & Davidson, P. (2004). An insight into Australian nurses' experience of withdrawal/withholding of treatment in the ICU. Intensive & Critical Care Nursing, 20(4), 214-222. Hansen, L., Goodell, T. T., Dehaven, J., & Smith, M. (2009). Nurses' perceptions of end-of-life care after multiple interventions for improvement. American Journal of Critical Care, 18(3), 263-271. Heyland, D. K., Rocker, G. M., O'Callaghan, C. J., Dodek, P. M., & Cook, D. J. (2003). Dying in the ICU: perspectives of family members. Chest, 124(1), 392-397. Hodde, N. M., Engelberg, R. A., Treece, P. D., Steinberg, K. P., & Curtis, J. R. (2004). Factors associated with nurse assessment of the quality of dying and death in the intensive care unit. Critical Care Medicine, 32(8), 1648-1653. Hopkinson, J. B., Hallett, C. E., & Luker, K. A. (2003). Caring for dying people in hospital. Journal of Advanced Nursing, 44(5), 525-533. Iranmanesh, S., Dargahi, H., & Abbaszadeh, A. (2008). Attitudes of Iranian nurses toward caring for dying patients. Palliative and Supportive Care, 6(4), 363-369. Iranmanesh, S., Haggstrom, T., Axelsson, K., & Savenstedt, S. (2009). Swedish nurses' experiences of caring for dying people: a holistic approach. Holistic Nursing Practice, 23(4), 243252. Luce, J. M., & Wachter, R. M. (1994). The ethical appropriateness of using prognostic scoring systems in clinical management. Critical Care Clinics, 10(1), 229-241. Luce, J. M., & White, D. B. (2007). The pressure to withhold or withdraw life-sustaining therapy from critically ill patients in the United States.[see comment]. American Journal of Respiratory & Critical Care Medicine, 175(11), 1104-1108. Mak, J. M., & Clinton, M. (1999). Promoting a good death: an agenda for outcomes research--a review of the literature. Nursing Ethics, 6(2), 97-106. McMillen, R. E. (2008). End of life decisions: nurses perceptions, feelings and experiences. Intensive & Critical Care Nursing, 24(4), 251-259. Meltzer, L. S., & Huckabay, L. M. (2004). Critical care nurses' perceptions of futile care and its effect on burnout. Am Journal of Critical Care, 13(3), 202-208. Mosenthal, A. C. (2002). Managing Death in the Intensive Care Unit: The Transition from Cure to Comfort. Journal of Pain and Symptom Management, 23(1), 83-84. Mosenthal, A. C. (2005). Palliative care in the surgical ICU. Surgical Clinics of North America, 85(2), 303-313. Mularski, R. A. (2006). Defining and measuring quality palliative and end-of-life care in the intensive care unit. Critical Care Medicine, 34(11), S309-316. Nelson, J. E. (2006). 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Nurses’ attitudes and behavior toward end-of-life care for terminally ill cancer patients
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Department of Nursing 102 2 103
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2014-07-07 163 -
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attitudes and behavior nurses terminally ill cancer patients end-of life care
7131 End-of-life care, EOL care 133Ajzen1985Theory of planned behavior, TPBEnd-of-life Care Competence Scale, EOLCCSEOL careEOL careEOL careEOL care /TPB 15014596.7%12133308N22.93=1.021-563.7%33.49=1.150-645%4EOL care123EOL care 3.39=1.240-580.1%360.9%42.1%EOL care36%28.6%~41.4%EOL careEOL careEOL care N3Mean = 4.5~5.4Mean = 2.0~2.9EOL care31.6% 38%/EOL careMean = 4.10-4.60Mean = 1.43-3.86EOL care34.3%EOL carePerceived behavioral controlF = 16.49, p < 0.001, R2 = 20.2% EOL careEOL careEOL care SUMMARY The purpose of this study is to investigate nurses’ attitudes and behavior toward end-of-life (EOL) care for terminally ill cancer patients. The study applied a descriptive correlational research design. Choose 133 nurses from medical center in southern Taiwan as participants, use EOLCCS questionnaire as research instrument to collect data, and analyze how personal characteristics, professional characteristics, past experience affect attitudes and behavior toward EOL care by descriptive statistics, one way ANOVA, correlation and multiple linear regression. The results showed that personal characteristics, professional characteristics, past experience only can increase their knowledge and skills but not belief, positive attitude and intention. Moreover, it is found that “knowledge and skills “ and “nursing level” are not in direct proportion, nurses who at N3 performed the best. Nurses worked in hospice ward performed the best (Mean = 4.5-5.4) and who worked in gynecology ward performed the worst (Mean = 2.0-2.9) in the knowledge and skill level. This study reveals that we should design more EOL care training programs which are according to clinical situation for clinical nurses, and affective teaching should be included to increase their belief and attitude toward EOL care. Finally nurses can increase their EOL care competence and elevate the quality of EOL care. Key words: attitudes and behavior, nurses, terminally ill cancer patients, end-of life care
INTRODUCTION Cancer has been the leading cause of death in Taiwan and the world. There are more and more people die because of cancer. Before their death, most of them need to be hospitalized for the symptomatic control, (e.g., pain, fatigue, dyspnea, delirium, etc.), and because the time and social environment changes, there are more and more patients die in the hospital. The number of deaths attributable to cancer is continuing to increase in hospital. Therefore, nurses will be the key person to care the terminally ill cancer patients. Nurses will feel anxiety, stress, helpless when caring end-of-life patients, and the quality of nursing care and demission rate will be influenced by their attitudes and experiences toward end-of-life care. So this is an important issue to be discussed. The purpose of this study is to investigate nurses’ attitudes and behavior toward end-of-life (EOL) care for terminally ill cancer patients. MATERIALS AND METHODS Choose a medical center in southern Taiwan as a research field. And selects 133 nurses as participants by applying convenience sampling , then collect information by structure questionnaire named “End-of-life Care Competence Scale (EOLCCS)”, which with 6 subscales, “Clinical decision knowledge”, “clinical treatment”, “pre-dying identification”, “belief”, “positive attitude”, “intention to care” . Analyze how personal characteristics, professional characteristics, past experience affect attitudes and behavior toward EOL care by descriptive statistics, one way ANOVA, correlation and multiple linear regression, and then investigate the nurses’ needs of resource for EOL care, units support of EOL care, coping strategies for frustration on doing EOL care, finally test the suitability of the theory of planned behavior on this research. RESULTS AND DISCUSSION This research has send out 150 questionnaires, took back145 questionnaires, response rate is 96.7%, and deleted 12 nurses’ questionnaires which didn’t meet the inclusion criteria, a total of 133 questionnaires were used for analysis. Most nurses were female, and unmarried with a mean age of 30. Most of them have university degrees, with a mean nursing working year of 8, nursing level at N2. The average score of “ Clinical decision ” is 2.93 (SD = 1.02, range: 1-5), there were 63.7% nurses can reach the passing score ( 3 point); the average score of “ Clinical treatment ” is 3.49 (SD = 1.15, range: 0-6), there were 45% nurses can reach the passing score ( 4 point).The reason nurses couldn’t provide EOL care appropriate are (1) Thinking and actual behavior were not consistent (2) Always by order to do nursing care, lack of critical thinking (3) Not familiar with the knowledge and treatment of EOL care. The average score of “Pre-dying sign knowledge” is 3.39 (SD = 1.24, range: 0-5), most (80.1%) of the nurses can reach the passing score ( 3 point) , “Mirror tongue” and “Terminal dehydration” are two concepts nurses were not familiar with. There were 36%28.6%~41.4%nurses would like to provide EOL care in the unfavorable condition. Nurses’ personal characteristic (eg. age, marriage status, education level), professional characteristic (eg. nursing working years, nursing level, work unit, special training) and past experience (eg. work at hospice wards, care the terminally ill cancer patients often) only can increase clinical decision knowledge, clinical treatment, pre-dying identification but not belief, positive attitude and intention to care. Choose “nursing level” as a factor to analyze nurses’ clinical decision knowledge and clinical treatment, it is found that “clinical decision knowledge and clinical treatment “ and “nursing level” are not in direct proportion, nurses who at N3 performed the best; Choose “working unit” as a factor to analyze nurses’ clinical decision knowledge and clinical treatment , the result showed that nurses worked in hospice ward performed the best ( Mean = 4.5-5.4), nurses worked in gynecology ward performed the worst (Mean = 2.0-2.9). “Communication skill” (31.6%) is the most needed courses for nurses, and increase “manpower of nurses”(38%) is the most important key impact factor for providing appropriate EOL care. Hospice wards provide the most support of EOL care ( Mean: 4.10-4.60); Pediatric wards provide the least support of EOL care (Mean:1.43-3.86). The coping strategies of most nurses when they suffering with setback is “Share with colleagues and get support”(34.3). EOL care behavior cannot be predicted only by “Intention”, it must to add “Perceived behavioral control” into the regression model to successfully predict EOL care behavior in TPB (F = 16.49, p < 0.001, R2 = 20.2%). CONCLUSION The research result is expected to enhance the nursing professionals’ caring skill as well as to increase the knowledge base through integrating and analyzing the data of nurses’ attitudes and experiences toward end-of-life care for terminally ill cancer patients . Then design a education programs or training programs based on the result for EOL care class in nursing schools and hospital units. And nursing administration staff can manage manpower properly and create an appropriate environment for providing EOL care. Finally, based on this research, more and more related research can be conducted, then integrate the findings to develop a local EOL care system. ..................................... II Abstract ................................. V .................................... VIII ................................... XI ................................... XII ................................. XIII ............................... 1 ............................ 1 ...................... 3 () ................. 3 () .......... 3 ...................... 4 ............................. 5 ............................. 5 ............................. 6 () ( Terminally ill cancer patients) ......................................... 6 () ( End-of-life care, EOL care) ........................................... 6 () Nurses’attitudes toward EOL care .....................................8 () Nurses’ behavior toward EOL care .................................... 9 ............................. 10 Theory of planned behavior, TPB .......................................... 10 () Theory of planned behavior, TPB .......................................... 10 () ........................................... 11 ........................... 12 () ............ 12 () .................... 13 ....... 14 () .. 14 () .......... 15 () .. 15 .......................... 19 .......................... 19 ............................... 20 ............................... 20 ............................. 20 .............................. 20 ............................... 21 Rigorous .............. 33 ............................ 39 ............................ 40 -1 .............................. 41 -2 .............................. 42 ............................. 43 ................................ 47 ................................ 49 ............................. 49 ............................. 51 .................................... 91 ......... 91 Research strength ............ 109 ( Limitation ) ................. 110 Implication ... 111 ................................... 114 ..................................... 115 .......................... 30 (CVI) ..................... 51 ............................ 52 . ..................... 53 . ................. 54 EOL care . 56 .......... 56 -1 ............. 57 -2 ............. 58 -3 ...... 59 -4 ... 59 -5 .... 60 -6 ...... 60 -7 ................ 61 -8 ... 62 -9 .. 62 -10 .... 63 -11 ..... 64 -12 .. 64 -13 ... 65 -14 .. 66 -15 ....... 67 -16 .... 67 -17 ... 68 -18 ........... 69 -19 ........... 69 -20 ................. 71 -1 ........... 72 -2 ............. 73 -3 .............. 73 -4 .......... 74 -5 .......... 74 -1 ()()EOL care 75 -2EOL care ... 76 -3EOL care . 76 -4EOL care 77 ........................78 ........................... 78 ............................ 79 ......................... 80 ........................ 81 .............. 82 / ....... 83 / ..... 83 ................ 84 EOL care ........................ 85 EOL care ......................... 86 EOL care/ ............ 87 ....89 .. 90 Trajectory of disease progress ...................... 2 ............ 2 ..... 8 ....... 11 ........ 125 ........ 126 ............... 127 .......... 128 ......... 131 .. 132 .... 143 ........ 155 20142014620 http://health.sina.com.cn/hc/2014-01-14/0948121026.shtml 1994 1995 2002 13(4)328-338 201310120131218 http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=12336&class_no=440&level_no=4 2013 10200000811 2007- 20062014625 http://www.hospice.org.tw/2009/chinese/hospital-3.php 2005 2011 1998 14913-18 2006 2010-SPSS(PASW) 116 1999 16(4)381-391 2012 1994 1994-2014319 http://dict.revised.moe.edu.tw/cgi-bin/newDict/dict.sh? cond=%BAA%AB%D7&pieceLen=50&fld=1&cat=&ukey=387776958&serial=1&recNo=0&op=f&imgFont=1 1994-2014319http://dict.revised.moe.edu.tw/cgi-bin/newDict/dict.sh? cond=%A6%E6%AC%B0&pieceLen=50&fld=1&cat=&ukey=1726497152&serial=1&recNo=13&op=f&imgFont=1 200646462-68 200721(4)53-60 2010 2005 10(4)358-370 201229(3)220-224 2004 3 (449-59 2008 19 (4450-460 117 2002 201116(1) 62-73 2006 19(4) 395-415 1986 1996 2002 2000 25(11)418-422 1991I 2000 8(2)214-226 20124 2007 2007 1995V. 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The Impact of Personality on Work-Family Conflict and Job Performance for Nurses
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Department of Industrial and Information Management 102 1 103
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2014-01-14 103 -
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Nurses Personality Work and Family Conflict Job Stress Job Performance
2012 57.68% 240 135 56.25%(1)(2)(3)(4)(5)(6) The issue of human resources in regard to nursing staff is our current domestic topic because nurses are the main manpower in medical institutions of healthcare. Nursing staff take care of patients at the front line and make contact with them frequently. However, according to a survey of Taiwan Union of Nurses Association in 2012, it was shown that employment rate of nursing staff was only 57.68%. Many nurses had nursing licenses but unwilling to work or continue working in hospitals because they always worked overtime and felt a lot of stress. The nature of nursing work also causes work-family conflicts influencing the daily life of nurses. As a result, the turnover rate for nursing staff is very high. Especially within recent years, many nurses leaving their jobs has resulted in serious nursing shortage and influenced the quality of health care in hospitals. Job stress and work-family conflict are the main reasons that nurses quitted their jobs. However, there are nurses still willing to keep working in hospitals. In addition to having passion for nursing work, this study aimed to explore whether personality was the reason or not for handling. Current researches into nurses always explored job satisfaction, job stress, job performance and turnover intention. Quite a few studies took personality or work-family conflict into consideration. Therefore, this study aimed to focus on investigating the relationships among personality, work-family conflict, job stress, and job performance. Data in this study were collected with self-developed questionnaires. Two hundred forty questionnaires were sent to the nurses who work in the public or private hospital of Taichung. Total amount of effective returns was 135 with a response rate of 56.25%. Regression analysis was employed to analyze the data. Result of this study showed that: (1) Personality has a significant impact on work-family conflict; (2) Personality has a significant impact on job performance; (3) Work-family conflict has a significant positive effect on job stress; (4) Job stress has a significant negative effect on job performance; (5) Work-family conflict negatively affects job performance; (6) Job stress has a mediating effect on the relationship between work-family conflict and job performance. Based on the results, this study suggested that people with curtain personality do fit in nursing work, so managers in hospital are able to select right nurses based on personality. Additionally, improving clinical environment can potentially reduce nurses’ perceived work-family conflict and job stress, and in turns increasing job performance. ................................................1 ........................................1 .............................................3 .............................................3 .....................................4 1.4.1 .............................................4 1.4.2 .............................................4 .............................................6 ................................6 2.1.1 .........................................6 2.1.2 ..................................6 2.1.3 ..................................8 .............................................9 2.2.1 .......................................9 2.2.2 ...............................10 2.2.3 ........................................13 ......................................15 2.3.1 .................................15 2.3.2 .................................16 2.3.3 .................................17 2.3.4 .................................18 ............................................19 2.4.1 ......................................19 2.4.2 ......................................21 2.4.3 .................................22 2.4.4 ......................................23 ............................................24 2.5.1 ......................................25 2.5.2 ...................................26 2.5.3 ...................................26 2.5.4 ...............................27 .....................................28 ............................................29 ............................................30 ...................................30 3.1.1 ............................................30 3.1.2 ............................................31 ............................................35 3.2.1 ........................................35 3.2.2 ........................................36 3.2.3 ...................................36 ...................................44 3.3.1 ............................................44 3.3.2 ........................................44 ............................................45 ............................................49 ........................................52 ........................................52 4.1.1 .................................52 4.1.2 .....................................55 4.1.3 ...............................56 ..........................................59 4.2.1 ............................................59 4.2.2 ............................................63 T ..............................69 ............................................69 ............................................70 ..........................................77 ............................................77 ......................................80 ........................................82 ..................................................84 ...................................93 -.................................94 -.................................98 -..................................102 . 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Burnout among Staff Nurses in Taiwan: Instrument Validation and Predictors Identification
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Institute of Allied Health Sciences 103 1 104
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2015-01-09 82 ()
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Taiwanese nurses burnout MBI-HSS Chinese version
1970 (1)(2)(3)(4) 483100 2084857%/3.590.920.90.052162522-327-1316-2433141580%66%75%35%18%39% Abstract Background Burnout in the nursing profession is a globally important problem because it affects individual, organizational, and patient outcomes. Burnout is a metaphor to describe people experiencing a state of emotional exhaustion similar to the extinguishing of a candle. Three components, emotional exhaustion (EE), personal accomplishment (PA), and depersonalization (DP), are included in burnout concepts. Nurse burnout has been investigated since the 1970s in western countries. The Maslach Burnout Inventory-Human Service Survey (MBI-HSS) has been widely used to measure burnout. However, the factor structure of the MBI-HSS differs in different cultures, countries, and healthcare provider systems; thus, researchers have suggested that larger sample sizes, expanding the data collection area, and different working environments are needed to investigate burnout differences across cultures, countries, and healthcare. Only two studies have investigated nurse burnout in Taiwan; both reported small sample sizes and focused on nurses working in specific specialties. However, neither identified suitable measurement instruments or predictors of burnout among Taiwanese nurses.
Aim The aims of this study were to (1) validate a tool suitable for measuring nurse burnout in Taiwan; (2) determine the current burnout levels and cut points of the MBI-HSS Chinese version; (3) investigate prevalence rates of nurse burnout in Taiwan; and (4) explore the predictors of nurse burnout in Taiwan. Methods Research design: Cross-sectional. Sample: Nurses from 483 hospitals accredited by the Taiwan Joint Commission on Hospital Accreditation and chosen using proportional stratified random sampling within a geographic area. The exclusion criteria were: working in a hospital with (1) fewer than 100 beds or (2) no surgical or medical units. Instrument: Two categories of data—demographic information and self-reported statements of the nurses’ perceptions of their work environment, job satisfaction, work engagement, and mental health—are included in the current study. Five different inventories were adapted to explore the nurses’ perceptions. Data analysis: In addition to descriptive statistics, exploratory factor analysis and confirmatory factor analysis were used to develop the instrument. The cut points of the burnoutmeasurement instrument for each level, low, moderate, and high were determined using level estimations and the K-mean grouping method. Finally, the predictors of burnout were investigated using hierarchical regression. Results Factor analysis showed an adequate fit between the three-factor 20-item model in the MBI-HSS Chinese version (MBI-HSS-CV). The new structure model contained eight items for emotional exhaustion, four items for depersonalization, and eight items for personal accomplishment, and the final result of variance was 57%. The validity indexes of the factor structure were x2/df = 3.59, GFI = 0.92, AGFI = 0.90, and RMSEA = 0.05. There were three levels of burnout. The level of burnout was low if scores of emotional exhaustion was less than 21, depersonalization was less than 6, and personal accomplishment was greater than 25; it is moderate if scores of emotional exhaustion ranged from 22 to 32, depersonalization 7 to 13, and personal accomplishment 16 to 24; and it was high if scores of emotional exhaustion was greater than 33, depersonalization was greater than 14, and personal accomplishment was less than 15. Eighty percent of the surveyed nurses reported more than moderate emotional exhaustion, 66% reported more than moderate depersonalization, and 75% reported more than moderate low personal accomplishment. Related factors for Taiwanese nurse burnout were age, mental health, job satisfaction, work engagement, and work environment. The most significant predictors were mental health and work engagement. The explained variances for each component were 35%, 18%, and 39% for emotional exhaustion, personal depersonalization, and accomplishment respectively. TABLE OF CONTENTS ABSTRACT......i ACKNOWLEDGMENTS.....vii LIST OF TABLES......x LIST OF FIGURES......xi CHAPTER 1 INTRODUCTION....1 CHAPTER 2 LITERATURE REVIEW.....4 2.1 Research on the history of burnout..4 2.2 Definition of burnout.....6 2.3 Nurse burnout in various countries..9 2.4 Burnout-related factors....11 2.5 Nurse outcomes related to burnout..24 2.6 Measuring burnout in nurses: Maslach Burnout Inventory-Human Services Survey....26 2.7 Research framework and hypothesis..29 CHAPTER 3 METHODS......32 3.1 Research design and data sources...32 3.2 Data collected in this study...35 3.3 Measurement instruments....35 3.4 Data analysis......39 CHAPTER 4 RESULTS......41 4.1 Factorial structure of the MBI-HSS Chinese version.41 4.2 Levels and cut points of the MBI-HSS Chinese version.48 4.3 The prevalence rate of burnout for nurses in Taiwan.50 4.4 The predictors of burnout for nurses in Taiwan.50 CHAPTER 5 DISCUSSION.....55 5.1 The factor structure of the Maslach Burnout Inventory Chinese version......55 5.2 Levels and cut points of the Maslach Burnout Inventory Chinese version......60 5.3 The prevalence rate of burnout for nurses in Taiwan.62 5.4 The predictors of burnout for nurses in Taiwan.64 CHAPTER 6 LIMITATIONS AND FUTURE RESEARCHES....…..66 CHAPTER 7 CONCLUSIONS....67 CHAPTER 8 REFERENCES.....68 Table 1. Demographic characteristics of the participants.34 Table 2. Critical ratio, correlations, item mean (SD), and skew of Maslach Burnout Inventory-Human Services Survey (MBI-HSS)..44 Table 3. The communality and factor loadings on structure matrix after re-structure MI-HSS...45 Table 4. K-mean grouping method of MBI-HSS Chinese version for emotional exhaustion, personal accomplishment, and depersonalization subscales....49 Table 5. Level and cut points of MBI-HSS Chinese version.49 Table 6. Prevalence rate of burnout among Taiwanese nurses.......50 Table 7. Burnout subscale scores by demographic variables.52 Table 8. Correlation among continuous variables..53 Table 9 Hierarchical regressions to predict burnout and subscale scores......54 Figure 1. Research framework...31 Figure 2. Modification structure of MBI-HSS..47 References Abrahamson, K., Jill Suitor, J., & Pillemer, K. (2009). Conflict between nursing home staff and residents’ families: does it increase burnout? 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Community Nurses’ Clinical Competency in Child Abuse: Public Health Centers and Outpatient Clinics in Southern Taiwan as an Example
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Department of Nursing 98 2 99
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2010-06-08 114 ()
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Community nurses Child abuse Clinical competency
650 5883979%20%20%4.6%9315.8% Background: Community nurses play various significant roles in child abuse, ranging from assessing health problems for children in the high risk family to providing appropriate interventions to resolve complex family difficulties. Understanding nurses’ clinical competency in child abuse and related factors is the essence for developing a culturally and clinically appropriate training program. Purpose: The purpose of this study was to explore community nurses’ clinical competency in child abuse. Methods: The research design is a cross-sectional, descriptive and correlational study. A convenience sampling was used to recruit 650 nurses from the communites in southern Taiwan. A structured questionnaire with 5 subscales, knowledge, skills, techniques, empowerment, team collaboration and self-reflection was developed and used for data collection. Results: A total of 588 questionnaires were returned and used for analysis. Most nurses were female, and married with a mean age of 39. About 79% of nurses worked in public health centers while 20% of nurses worked in outpatient clinics. Nearly 20% reported having acquaintance with a maltreatment history. Only 4.6% had experience of reporting child abuse case. Only 93 (15.8%) nurses correctly answered all items of knowledge scale. Most nurses perceived that they were skillful, possessed the abilities of empowerment, team collaboration and self-reflection. Except for knowledge subscale, outpatient clinic nurses scored higher for the other 4 subscales. Nurses’ clinical competence in child abuse was negatively correlated with nurses’ age and working experience. Nurses’ knowledge in child abuse was significantly and positively correlated with team collaboration and self-reflection. The rest of 4 subscales of clinical competence in child abuse were positively correlated with each other. Conclusion: Community nurses were not knowledgeable on child abuse. Very few nurses had experiences of reporting suspected child abuse cases. The hidden number of child abuse victims in the community cannot be overlooked. Training programs on child abuse in nursing continous education is needed to improve community nurses’ sensibility and clinical competence to manage child abuse in the community. I III V 1 1 4 5 5 6 8 8 10 10 15 19 26 26 27 28 32 32 33 35 35 39 48 63 63 71 74 31 36 CVI 37 38 41 42 46 49 52 52 T 54 56 57 58 59 61 62 1 27 2 40
91 92 94 96 97 107
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Public Health Nursing in Indonesia: Difference in Roles and Functions in Rural and Urban Centers
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Department of Nursing 102 1 103
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2014-01-15 112 -
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roles functions public health nurses rural-urban
:: Chamber (1994) Gibson’s (t = -2.98, p = .003) :
(2000)19850148SPSS17
Abstract Background: Public health nurses in Indonesia hold important roles and functions in the effort of achieving goals of health development in Indonesia. In general, there are two factors related to roles and functions, personal and contextual factors include setting. Therefore, to identify factors related to difference in roles and function of public health nurses in different location is an important step to build up the specific scope of practice. Purpose: To identify factors related to difference in roles and functions of public health nurses working in rural and urban public health centers. Methods: Cross-sectional study was conducted among nurses who work in pubic health center in Surabaya and Banyuwangi. A research instrument adapted from Chamber (1994) and Gibson’s (2000) has been calibrated with acceptable reliability and validity, and later being used for data collection. A total of 198 PHNs including 50 from rural area and 148 from urban areas were recruited. SPSS 17 was used for data analysis. Result: The results indicate that there was a gap in the importance of roles as perceived and frequency of function as practiced. There was no different in the importance of roles among PHNs in different setting, but when measured about functions there was signicant difference (t = -2.98, p = .003). PHNs in urban area have practiced more complex activities than PHNs in rural area. Using the regression approach, sum of job descriptions was the only predicting factor to importance of roles perceived by Indonesian public health nurses. Sum of job descriptions, employment status, total of training and setting were found to be predictors of the functions and settings is the most influential factor related to how PHNs apply their functions. Conclusion: In each setting, PHNs have different priorities in their activity. Through these findings can be referenced for future scope of public health nursing practice in different settings in term of roles and function of public health nursing in Indonesia. Keywords: roles, functions, public health nurses, rural-urban TABLE OF CONTENTS COVER i PASSING CERTIFICATE ii CHINESE ABSTRACT iii ENGLISH ABSTRACT iv ACKNOWLEDGEMENTS vi CONTENT vii LIST OF TABLE x LIST OF FIGURE xi CHAPTER 1 INTRODUCTIONS 1 1.1 Background and significant of study 1 1.2 Purposes statements 5 1.3 Definition 5 CHAPTER 2 LITERATURE REVIEW 8 2.1 Public Health 8 2.2 Public Health Nursing 9 2.2.1 Roles of Public Health Nurses 9 2.2.2 Functions of Public Health Nurses 11 2.3 Public Health Center in Indonesia (Puskesmas) 14 2.3.1 Functions of Public health center in Indonesia 16 2.3.2 Functions of Public Health Nurses 17 2.3.3 Health effort of Puskesmas 20 2.4 Conceptual framework 21 CHAPTER 3 METHODOLOGY 22 3.1 Research design 22 3.2 Population and Sampling 22 3.3 Instrument development 23 3.4 Data collections and ethical consideration 28 3.5 Data analysis 30 3.6 Operational definition 31 CHAPTER 4 RESULTS OF STUDY 35 4.1 Demographics variable 35 4.2 Roles of public health nursing 38 4.3 Functions of public health nursing 40 4.4 Comparative ranking of the roles and functions 48 4.5 Hypothesis testing 49 4.5.1 Difference in roles and functions of PHNs’ in rural and urban area 49 4.5.2 Correlations between roles and functions of PHNs’ with social demographic 50 4.5.3 Predictor factors for roles and functions of PHNs’ 52 CHAPTER 5 DISCUSSION and IMPLICATION 54 5.1 Summary of results and interpretation 54 5.2 Research limitations and suggestions 58 5.3 Implications 59 REFERENCE 61 APPENDIX 67 Appendix one Author Permit 67 Appendix two Original Instrument 71 Appendix three Recapitulation of content validity 82 Appendix Four Inform consent letter 92 Appendix Five Last instrument 94 Appendix Six Ethical approval 105 Appendix Seven Letter permit from Department of Health Surabaya 106 Appendix Eight Letter permit from Department of Health Banyuwangi 110 Reference Ahmad, S. 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The effectiveness of cancer communication training program for nurses in Taiwan
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Department of Nursing 99 2 100
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2011-07-11 76 -
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communication training program nurses simulated cancer patients communication competence communication skills
2 71 Medical Interview Aural Rating Scale, MIARS(2) Kalamazoo Essential Element Communication Checklist, KEECC-R(3) Kalamazoo Essential Element Communication Checklist, KEECC-N(4) Nurses’ Self-Efficacy Ratings in Oncology Specified Communication Tasks Scale, NSORSCT(5)Rochester Communication Rating Scale, RCRS 15 66 22 2 Objectives: To validate the effectiveness of a two-day cancer communication skill training program on nurse staffs in their communication competence, skills and confidence. Methods: A single group with quasi-experimental pre- and post-test research design was used. 71 nurses having cancer care experience were recruited from medical centers and regional hospital in Southern Taiwan. Instruments: Five instruments were used to assess the outcomes at 1 week before and 1 week after communication training program. There were including: Medical Interview Aural Rating Scale (MIARS), Kalamazoo Essential Element Communication Checklist-researcher rated (KEECC-R), Kalamazoo Essential Element Communication Checklist-nurse rated (KEECC-N), Nurses' Self-Efficacy Ratings in Oncology Specified Communication Tasks Scale (NSORSCT), and Rochester Communication Rating Scale (RCRS). The multiple outcome indexes were collected through nurse’s and simulated patient’s self-rating scores (KEECC-N, NSORSCT, RCRS), and researcher coding and rating scores from a15-min nurse-patient interview (MIARS, KEECC-R). InterventionParticipants attended a two-day communication skills training programme. The program began with a large group meeting for 6 hours, focusing on theoretic information, open discussions. Nurses were then divided into small groups of 3 or 4, in which one facilitators were assigned for 6 hours. One participant volunteered to play a nurse and another to play a patient in various scenarios involving a nurse’s follow-up situation. We prepared the following 4 scenarios, which took into account a suitable Taiwan medical system and culture. Results: Nurses’ communication competence and skills were coded and rated by two trained researchers independently based on The Observer XT coding software and MIARS. The descriptive and inferential statistics were used to analyze the data. The significant changes were found in MIARS, KEECC-R, NSROSCT and RCRS after a two-day cancer communication training program. Conclusions: Nurses’ confidence, emotional responding behaviors and facilitating behaviors increased including cue exploration and acknowledge; the distancing strategy and blocking behavior decreased after intervention. 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