Brenda Helen Sheingold

Measuring the Nursing Work Environment: Can a Social Capital Framework Add Value?

Background: A suite of robust instruments are required to investigate the range of contextual and social dimensions in the nursing workforce that contribute to desired outcomes such as resilient work environments, high retention rates, and provision of quality health care. However current instruments do not adequately measure the formal and informal social relationships between nurses and others on the team. This gap is problematic because social relationships can influence how well nurses work together to achieve the desired outcomes. To this end, instruments from other disciplines could be adapted to investigate social dimensions. Purpose: To examine how a social capital framework could measure social relationships in nursing work environments and inform policy and managerial initiatives to reduce turnover and improve quality. Method: Eight contemporary instruments that assess social dimensions and sub-scales in nursing work environments were reviewed. An instrument that measures social dimensions known as social capital (networks, norms, outcomes) was also reviewed for adaptation in nursing. Findings: The eight contemporary instruments do not adequately measure the nature of social relationships (networks, norms, outcomes) between nurses. A social capital instrument developed by social researchers and economists could be adapted to add value and understanding of social relationship issues. Policy Implications and Conclusions: It is timely to develop robust qualitative and quantitative instruments that will permit the examination of social capital in nursing populations globally, and identify mechanisms to achieve desired outcomes, such as job satisfaction, retention, and quality health care.

Medical Technology and the U.S. Healthcare System: Is This the Road to Abilene?

The conventional wisdom that Americans are unwilling to discuss limits to healthcare resources or tolerate any restrictions on treatment choices presents a formidable barrier to implementing policies that would reduce healthcare cost growth. Typical explanations for the conventional wisdom are plentiful, but not entirely useful in providing guidance for appropriate policy responses. In this paper, we analyze an organizational theory known as the Abilene Paradox to explain the lack of public engagement and the paucity of research concerning public values and preferences on difficult healthcare issues such as the use of medical technology. The analysis suggests that one strategy for improving policymaking would be to expand on recent research efforts concerning public participation in decisions about medical technology. These efforts demonstrate that when structured, deliberative methods are employed, members of the public are both willing and able to engage as social decision makers for allocating limited resources.