Ann Bonner

Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature.

AIM To explore and discuss from recent literature the common factors contributing to nurse job satisfaction in the acute hospital setting. BACKGROUND Nursing dissatisfaction is linked to high rates of nurses leaving the profession, poor morale, poor patient outcomes and increased financial expenditure. Understanding factors that contribute to job satisfaction could increase nurse retention. EVALUATION A literature search from January 2004 to March 2009 was conducted using the keywords nursing, (dis)satisfaction, job (dis)satisfaction to identify factors contributing to satisfaction for nurses working in acute hospital settings. KEY ISSUES This review identified 44 factors in three clusters (intra-, inter- and extra-personal). Job satisfaction for nurses in acute hospitals can be influenced by a combination of any or all of these factors. Important factors included coping strategies, autonomy, co-worker interaction, direct patient care, organizational policies, resource adequacy and educational opportunities. CONCLUSIONS Research suggests that job satisfaction is a complex and multifactorial phenomenon. Collaboration between individual nurses, their managers and others is crucial to increase nursing satisfaction with their job. IMPLICATIONS FOR NURSING MANAGEMENT Recognition and regular reviewing by nurse managers of factors that contribute to job satisfaction for nurses working in acute care areas is pivotal to the retention of valued staff.

Examining the knowledge, attitude and use of research by nurses

AIM This study sought to determine the knowledge, attitudes and use of research by nurses. BACKGROUND There is little evidence about whether nurses are aware of using research and how much research they use in their clinical practice. METHOD Using a descriptive design, 347 registered and Enrolled Nurses completed the Edmonton Research Orientation Survey. RESULTS Senior Nurse Managers were more likely to have a positive attitude towards research, and completion of university subjects on nursing research was significant in determining attitude and knowledge of research. All nurses, regardless of position identified barriers to performing research. CONCLUSION Nurses require specific research education, clinical nursing leadership and work environments conducive to ensure practice is evidenced-based. IMPLICATIONS FOR NURSING MANAGEMENT A positive attitude towards research by Senior Nurse Managers has the potential to influence other nurses in establishing an active nursing research culture and promote evidence-based practice in the workplace.

SYMPTOM BURDEN IN CHRONIC KIDNEY DISEASE: A REVIEW OF RECENT LITERATURE

BACKGROUND People living with chronic kidney disease (CKD) experience multiple symptoms due to both the disease and its treatment. However, these symptoms are often underrecognised. In addition, the majority of studies have focused on an individual symptom; however, these symptoms rarely occur in isolation and may instead occur in clusters. AIM OF REVIEW To investigate the total symptom burden in advanced CKD (Stages 4 and 5) and to identify the key instruments that are used to assess multiple symptoms. METHODS A literature search from 2006 to 2012 was undertaken and a total of 19 articles were included. RESULTS The most common CKD symptoms were fatigue or lack of energy, feeling drowsy, pain and pruritus. However, symptom assessment instruments varied between studies, often with inconsistent or inadequate symptom dimensions. CONCLUSION People with CKD experience a high symptom burden, although little is known about the burden for people with CKD Stage 4 and for those with CKD Stage 5 receiving peritoneal dialysis. This review recommends that a full range of symptoms be assessed for those at different stages of CKD. Improved understanding of the burden of symptoms can be used as the basis for treatment choices and for identifying priorities which are likely to contribute to a better quality of life and improve the quality of care.

The impact of fatigue on daily activity in people with chronic kidney disease

AIMS AND OBJECTIVES To examine the impact of fatigue on the daily activity levels of people with chronic kidney disease, compare whether being predialysis or receiving different renal replacement therapies had any effect on fatigue and activity and identify whether any items in the fatigue severity scale were more predictive of daily activity levels. BACKGROUND Chronic kidney disease is a complex and long-term disease where people commonly experience fatigue and reduced levels of fitness; both of which impact on an individuals ability to carry out routine activities of daily life. DESIGN A descriptive cross-sectional design. METHODS A convenience sample of 112 people completed the fatigue severity scale and Human Activity Profile. Participants differed in their renal history and were either predialysis or receiving renal replacement therapy. RESULTS Women or older participants were significantly more fatigued and less active than men or younger participants. A significant difference between mean fatigue and activity scores was found for type of renal replacement therapy, with participants receiving peritoneal dialysis being the most fatigued and the least active. Additionally, lower levels of albumin were significantly correlated with greater levels of fatigue and the ability to engage in fewer activities. CONCLUSION People with chronic kidney disease regardless of whether they are predialysis or receiving either peritoneal or haemodialysis experience high levels of fatigue and are able to engage in fewer daily activities. The fatigue severity scale and the Human Activity Profile are useful indicators of fatigue and physical activities which can be used in routine assessment practices. RELEVANCE TO CLINICAL PRACTICE Renal nurses are ideally positioned to engage in early identification and regular monitoring of both fatigue and activity levels in people with chronic kidney disease. Individual care plans can be developed to incorporate supportive rehabilitative strategies which aim to reduce fatigue and maximise activity levels.

Why do nurses migrate? - a review of recent literature.

AIM To identify the reasons why nurses continue migrating across international borders. BACKGROUND International nurse recruitment and migration have been increasing in the last decade and recent trends show an increase in the movement of nurses between developing and developed countries, resulting in a worldwide shortage of nurses. METHODS A manual and electronic database literature search was conducted from January 2004 to May 2010. Qualitative content analysis was completed for the final 17 articles that satisfied the inclusion criteria. RESULTS Motivators to nurse migration were linked to financial, professional, political, social and personal factors. Although economic factors were the most commonly reported, they were not the only reason for migration. This was especially evident among nurses migrating between developed countries. CONCLUSION Nurses migrate for a wide variety of reasons as they respond to push and pull factors. IMPLICATIONS FOR NURSING MANAGEMENT It is important for nurse managers in the source countries to advocate incentives to retain nurses. In the recipient countries the number of international nurses continues to increase implying the need for more innovative ways to mentor and orientate these nurses.

What information counts at the moment of practice? Information practices of renal nurses

AIMS This article is a report of a study done to identify how renal nurses experience information about renal care and the information practices that they used to support everyday practice. BACKGROUND What counts as nursing knowledge remains a contested area in the discipline yet little research has been undertaken. Information practice encompasses a range of activities such as seeking, evaluation and sharing of information. The ability to make informed judgement is dependent on nurses being able to identify relevant sources of information that inform their practice and those sources of information may enable the identification of what knowledge is important to nursing practice. METHOD Habermas and Schatzki; it employed qualitative research techniques. Using purposive sampling six registered nurses working in two regional renal units were interviewed during 2009 and data was thematically analysed. FINDINGS The information practices of renal nurses involved mapping an information landscape in which they drew on information obtained from epistemic, social and corporeal sources. They also used coupling, a process of drawing together information from a range of sources, to enable them to practice. CONCLUSION Exploring how nurses engage with information, and the role the information plays in situating and enacting epistemic, social and corporeal knowledge into everyday nursing practice is instructive because it indicates that nurses must engage with all three modalities in order to perform effectively, efficiently and holistically in the context of patient care.

Work environment, job satisfaction, stress and burnout among haemodialysis nurses

AIM To examine the relationships among nurse and work characteristics, job satisfaction, stress, burnout and the work environment of haemodialysis nurses. BACKGROUND Haemodialysis nursing is characterised by frequent and intense contact with patients in a complex and intense environment. METHOD A cross-sectional online survey of 417 haemodialysis nurses that included nurse and work characteristics, the Brisbane Practice Environment Measure, Index of Work Satisfaction, Nursing Stress Scale and the Maslach Burnout Inventory. RESULT Haemodialysis nurses reported an acceptable level of job satisfaction and perceived their work environment positively, although high levels of burnout were found. Nurses who were older and had worked in haemodialysis the longest had higher satisfaction levels, experienced less stress and lower levels of burnout than younger nurses. The in-centre type of haemodialysis unit had greater levels of stress and burnout than home training units. Greater satisfaction with the work environment was strongly correlated with job satisfaction, lower job stress and emotional exhaustion. CONCLUSION Haemodialysis nurses experienced high levels of burnout even though their work environment was favourable and they had acceptable levels of job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT Targeted strategies are required to retain and avoid burnout in younger and less experienced nurses in this highly specialised field of nursing.

SELF-MANAGEMENT PROGRAMMES IN STAGES 1–4 CHRONIC KIDNEY DISEASE: A LITERATURE REVIEW

BACKGROUND Chronic kidney disease (CKD) is a complex health problem, which requires individuals to invest considerable time and energy in managing their health and adhering to multifaceted treatment regimens. OBJECTIVES To review studies delivering self-management interventions to people with CKD (Stages 1-4) and assess whether these interventions improve patient outcomes. DESIGN Systematic review. METHODS Nine electronic databases (MedLine, CINAHL, EMBASE, ProQuest Health & Medical Complete, ProQuest Nursing & Allied Health, The Cochrane Library, The Joanna Briggs Institute EBP Database, Web of Science and PsycINFO) were searched using relevant terms for papers published between January 2003 and February 2013. RESULTS The search strategy identified 2,051 papers, of which 34 were retrieved in full with only 5 studies involving 274 patients meeting the inclusion criteria. Three studies were randomised controlled trials, a variety of methods were used to measure outcomes, and four studies included a nurse on the self-management intervention team. There was little consistency in the delivery, intensity, duration and format of the self-management programmes. There is some evidence that knowledge- and health-related quality of life improved. Generally, small effects were observed for levels of adherence and progression of CKD according to physiologic measures. CONCLUSION The effectiveness of self-management programmes in CKD (Stages 1-4) cannot be conclusively ascertained, and further research is required. It is desirable that individuals with CKD are supported to effectively self-manage day-to-day aspects of their health.

The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review.

Background Chronic diseases are increasing worldwide and have become a significant burden to those affected by those diseases. Disease‐specific education programs have demonstrated improved outcomes, although people do forget information quickly or memorize it incorrectly. The teach‐back method was introduced in an attempt to reinforce education to patients. To date, the evidence regarding the effectiveness of health education employing the teach‐back method in improved care has not yet been reviewed systematically. Objectives This systematic review examined the evidence on using the teach‐back method in health education programs for improving adherence and self‐management of people with chronic disease. Inclusion criteria Types of participants Adults aged 18 years and over with one or more than one chronic disease. Types of intervention All types of interventions which included the teach‐back method in an education program for people with chronic diseases. The comparator was chronic disease education programs that did not involve the teach‐back method. Types of studies Randomized and non‐randomized controlled trials, cohort studies, before‐after studies and case‐control studies. Types of outcomes The outcomes of interest were adherence, self‐management, disease‐specific knowledge, readmission, knowledge retention, self‐efficacy and quality of life. Search strategy Searches were conducted in CINAHL, MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, ProQuest Nursing and Allied Health Source, and Google Scholar databases. Search terms were combined by AND or OR in search strings. Reference lists of included articles were also searched for further potential references. Methodological quality Two reviewers conducted quality appraisal of papers using the Joanna Briggs Institute Meta‐Analysis of Statistics Assessment and Review Instrument. Data extraction Data were extracted using the Joanna Briggs Institute Meta‐Analysis of Statistics Assessment and Review Instrument data extraction instruments. Data synthesis There was significant heterogeneity in selected studies, hence a meta‐analysis was not possible and the results were presented in narrative form. Results Of the 21 articles retrieved in full, 12 on the use of the teach‐back method met the inclusion criteria and were selected for analysis. Four studies confirmed improved disease‐specific knowledge in intervention participants. One study showed a statistically significant improvement in adherence to medication and diet among type 2 diabetics patients in the intervention group compared to the control group (p < 0.001). Two studies found statistically significant improvements in self‐efficacy (p = 0.0026 and p < 0.001) in the intervention groups. One study examined quality of life in heart failure patients but the results did not improve from the intervention (p = 0.59). Five studies found a reduction in readmission rates and hospitalization but these were not always statistically significant. Two studies showed improvement in daily weighing among heart failure participants, and in adherence to diet, exercise and foot care among those with type 2 diabetes. Conclusions Overall, the teach‐back method showed positive effects in a wide range of health care outcomes although these were not always statistically significant. Studies in this systematic review revealed improved outcomes in disease‐specific knowledge, adherence, self‐efficacy and the inhaler technique. There was a positive but inconsistent trend also seen in improved self‐care and reduction of hospital readmission rates. There was limited evidence on improvement in quality of life or disease related knowledge retention. Implications for practice Evidence from the systematic review supports the use of the teach‐back method in educating people with chronic disease to maximize their disease understanding and promote knowledge, adherence, self‐efficacy and self‐care skills. Implications for research Future studies are required to strengthen the evidence on effects of the teach‐back method. Larger randomized controlled trials will be needed to determine the effectiveness of the teach‐back method in quality of life, reduction of readmission, and hospitalizations.

JOB SATISFACTION, STRESS AND BURNOUT ASSOCIATED WITH HAEMODIALYSIS NURSING: A REVIEW OF LITERATURE

Job dissatisfaction, stress and burnout are linked to high rates of nurses leaving the profession, poor morale and poor patient outcomes. Haemodialysis (HD) nursing is uniquely characterised by the intense-prolonged interaction with patients who require complex technological care. A review of nine papers found that factors affecting job satisfaction were aspects of nursing care, organisational factors and length of time that a nurse has been working in nephrology nursing. Factors affecting job stress and burnout were due to interpersonal relationships with physicians, patient care activities, violence and abuse from patients, organisational factors and a lack of access to ongoing education.