Martha MacLeod

Psychosocial safety climate as an antecedent of work characteristics and psychological strain: A multilevel model

Abstract Psychosocial safety climate (PSC) refers to a specific organizational climate for the psychological health of workers. It is largely determined by management and at low levels is proposed as a latent pathogen for psychosocial risk factors and psychological strain. Using an extended Job Demands-Control-Support framework, we predicted the (24 month) cross-level effects of PSC on psychological strain via work conditions. We used a novel design whereby data from two unrelated samples of nurses working in remote areas were used across time (N=202, Time 1; N=163, Time 2), matched at the work unit level (N= 48). Using hierarchical linear modelling we found that unit PSC assessed by nurses predicted work conditions (workload, control, supervisor support) and psychological strain in different nurses in the same work unit 24 months later. There was evidence that the between-group relationship between unit PSC and psychological strain was mediated via Time 2 work conditions (workload, job control) as well as Time 1 emotional demands. The results support a multilevel work stress model with PSC as a plausible primary cause, or “cause of the causes”, of work-related strain. The study adds to the literature that identifies organizational contextual factors as origins of the work stress process.

Moving on? Predictors of intent to leave among rural and remote RNs in Canada

CONTEXT Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. PURPOSE This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this project, potential predictors of ITL were related to the individual RN worker, the workplace, the community context, and satisfaction related to both the workplace and the community(s) within which the RN lived and worked. METHODS A national cross-sectional mail survey of RNs in rural and remote Canada provided the data (n = 3,051) for the logistic regression analysis of predictors of ITL. FINDINGS We found that RNs were more likely to plan to leave their nursing position within the next 12 months if they: were male, reported higher perceived stress, did not have dependent children or relatives, had higher education, were employed by their primary agency for a shorter time, had lower community satisfaction, had greater dissatisfaction with job scheduling, had lower satisfaction with their autonomy in the workplace, were required to be on call, performed advanced decisions or practice, and worked in a remote setting. CONCLUSIONS The statistical evidence for predictors of ITL supported our framework with determinants related to the individual, the workplace, the community, and satisfaction levels. The importance of community makes this framework uniquely relevant to the rural health context. Our findings should guide policy makers and employers in developing retention strategies.

Levels of occupational stress in the remote area nursing workforce

OBJECTIVE   To identify key workplace demands and resources for nurses working in very remote Australia and measure levels of occupational stress in this population. METHODS   The study used a cross-sectional design, utilising a structured questionnaire. SETTING   Health centres in very remote Australia. RESULTS   Nurses working in very remote Australia experience significantly higher levels of psychological distress and emotional exhaustion, compared with other professional populations. Paradoxically, results also highlight higher than average levels of work engagement. Nurses working in very remote regions in Australia further report moderate levels of job satisfaction. Most significant job demands identified were emotional demands, staffing issues, workload, responsibilities and expectations, and social issues. Key job resources included supervision, opportunities for professional development, and skill development and application. CONCLUSION   In a context of high stress, high levels of work engagement and moderate levels of job satisfaction do not obviate high workforce turnover for this population. There is a need to reduce job demands and increase job resources in order to foster long-term work engagement and reduced emotional exhaustion. This might subsequently decrease remote area nursing workforce turnover.

Group medical visits can deliver on patient-centred care objectives: results from a qualitative study

BackgroundPatient-centred care emerged in the late 1960s as a framework to guide providers and decision-makers towards the provision of more effective health care and better outcomes. An important body of literature has since emerged, reporting mixed results in terms of outcomes. To date, assessments of the effectiveness of patient-centred approaches have focused one-on-one consultations. The purpose of this article is to explore dimensions identified as key in the patient-centred literature in the context of primary health care services delivered in a group setting. Group Medical Visits (GMVs) offer a novel format for the delivery of patient-centred primary health care services, especially for patients living with complex morbidities.MethodsDrawing on a large study of GMVs, we report on key format and process-oriented elements identified in GMVs, and on their link to improved outcomes. For the purpose of this study, we interviewed 34 providers and 29 patients who have been engaged in GMVs, delivered in rural, northern and First Nation communities in British Columbia, Canada.ResultsOur analysis shows that the delivery of PHC in a group format results in a shift in the role of the provider, from that of an adjudicator involved in imparting norms of self-care, to that of a facilitator who assists the group in defining norms of self-care that are based on medical knowledge but also on the broader context of patients’ lived experience and on their pragmatic experience. In a group process, peer-patients take on the role of promoting these norms to other patients. This results in a significant shift in the role of the provider, increased trust, increased knowledge for the providers and the patients and better patient self-management. Our results also show increase satisfaction for patients and providers.ConclusionsGMVs offer an alternative format for the provision of PHC that brings together the benefit of a group process and of a clinical encounter. This format can successfully deliver on the promises of patient-centred care.

The need for significant reform: a practice-driven approach to curriculum.

The central theme of the curriculum revolution is the preparation of graduates with new and different perspectives and abilities who can function well in a rapidly changing health care environment. Discussions of approaches needed to prepare such graduates center on making substantive changes within the education system. Experience from a collaborative undergraduate nursing program reveal that revised structural and power relationships between nursing education and nursing practice are needed to support such fundamental changes in nursing curricula. This article explores structural and power relationship issues arising from implementing a practice-driven, phenomenological approach to a 4-year undergraduate nursing curriculum. The meaning of a practice-driven approach, the inherent benefits and risks, the outcomes and evaluation issues are included in the discussion. It is suggested that if learning to nurse is grounded in nursing practice as well as in nursing academia, then systems of nursing practice and of educating nurses must change.

‘Being there’: learning throughactive participation

Students engagement in learning is predicated not only on interest but on the perception of relevance to their needs. A hermeneutic interpretation of narrative student evaluation data from an introduction to nursing lecture course that was taught by means of a practice-based phenomenological approach revealed a pattern of student learning in which students moved from detachment to active participation in their learning. The stories shared by nurses in the practice setting were instrumental in introducing students to the world of nursing and facilitating a sense of belonging. Once engaged in the experience, students looked for opportunities to become active participants in their learning. A practice-based phenomenological approach to a theory course maximizes opportunities for student participation. Active reflection and integration allow students to make their own connections between theory and practice.

“And Then You'll See Her in the Grocery Store”: The Working Relationships of Public Health Nurses and High-Priority Families in Northern Canadian Communities

The aim of the study is to examine and articulate the nature of working relationships of public health nurses and high-priority families in small communities in northern Canada. Public health nurses working in northern, rural, and remote communities face unique and varied challenges. Reportedly, the hardest part of their job is working with families who have been deemed high priority or high risk. Working with these families in these contexts relies on relationships of reciprocity, trust, and communication. This qualitative research was guided by an interpretive hermeneutic inquiry; 32 families, 25 public health nurses, and three lay home visitors were interviewed from July 2005 through July 2006. Analysis was completed individually and through teamwork of the researchers. Findings suggest that the working relationship of public health nurses and high-priority families in northern communities is complex and multifaceted. Nurses carefully negotiate the process of engaging and entering relationships, maintaining the relationships, and negotiating boundaries. The analysis offers insight into the everyday practices and problems that public health nurses and families encounter in providing care to a vulnerable, isolated, and often marginalized population while navigating the complexity of living and working in the same small communities.

Understanding the performance and impact of public knowledge translation funding interventions: Protocol for an evaluation of Canadian Institutes of Health Research knowledge translation funding programs

BackgroundThe Canadian Institutes of Health Research (CIHR) has defined knowledge translation (KT) as a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products, and strengthen the healthcare system. CIHR, the national health research funding agency in Canada, has undertaken to advance this concept through direct research funding opportunities in KT. Because CIHR is recognized within Canada and internationally for leading and funding the advancement of KT science and practice, it is essential and timely to evaluate this intervention, and specifically, these funding opportunities.DesignThe study will employ a novel method of participatory, utilization-focused evaluation inspired by the principles of integrated KT. It will use a mixed methods approach, drawing on both quantitative and qualitative data, and will elicit participation from CIHR funded researchers, knowledge users, KT experts, as well as other health research funding agencies. Lines of inquiry will include an international environmental scan, document/data reviews, in-depth interviews, targeted surveys, case studies, and an expert review panel. The study will investigate how efficiently and effectively the CIHR model of KT funding programs operates, what immediate outcomes these funding mechanisms have produced, and what impact these programs have had on the broader state of health research, health research uptake, and health improvement.DiscussionThe protocol and results of this evaluation will be of interest to those engaged in the theory, practice, and evaluation of KT. The dissemination of the study protocol and results to both practitioners and theorists will help to fill a gap in knowledge in three areas: the role of a public research funding agency in facilitating KT, the outcomes and impacts KT funding interventions, and how KT can best be evaluated.

Nurses who work in rural and remote communities in Canada: a national survey

BackgroundIn Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions.MethodsA cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada.ResultsRural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses’ levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region.ConclusionsThe proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care.

Patient confidentiality within the context of group medical visits: is there cause for concern?

Group medical visits (GMVs), clinical encounters with a medical component delivered to groups of patients, have emerged as an innovative approach to potentially increasing efficiency while enhancing the quality of primary health care (PHC). GMVs have created the need to pay explicit attention to patient confidentiality.