Yupin Aungsuroch

Importance of work environments on hospital outcomes in nine countries

PURPOSE To determine the effect of hospital work environments on hospital outcomes across multiple countries. DESIGN Primary survey data using a common instrument were collected from separate cross sections of 98 116 bedside care nurses practising in 1406 hospitals in 9 countries between 1999 and 2009. MAIN OUTCOME MEASURES Nurse burnout and job dissatisfaction, patient readiness for hospital discharge and quality of patient care. RESULTS High nurse burnout was found in hospitals in all countries except Germany, and ranged from roughly a third of nurses to about 60% of nurses in South Korea and Japan. Job dissatisfaction among nurses was close to 20% in most countries and as high as 60% in Japan. Close to half or more of nurses in every country lacked confidence that patients could care for themselves following discharge. Quality-of-care rated as fair or poor varied from 11% in Canada to 68% in South Korea. Between one-quarter and one-third of hospitals in each country were judged to have poor work environments. Working in a hospital with a better work environment was associated with significantly lower odds of nurse burnout and job dissatisfaction and with better quality-of-care outcomes. CONCLUSIONS Poor hospital work environments are common and are associated with negative outcomes for nurses and quality of care. Improving work environments holds promise for nurse retention and better quality of patient care.

Impact of Nurse Work Environment and Staffing on Hospital Nurse and Quality of Care in Thailand

PURPOSE To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. DESIGN Secondary data analysis of the 2007 Thai Nurse Survey. METHODS The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. FINDINGS Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurses workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurses workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001). CONCLUSIONS Improving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. CLINICAL RELEVANCE Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world.

Psychological well-being Asian style: The perspective of Thai elders

Psychological well-being is animportant aspect of life quality for olderadults. Asian elders may have a distinctlydifferent perspective from Westernersconcerning the meaning of psychologicalwell-being. Using qualitative researchmethods, this study focused on the views of Thai elders. In-depth interviews and focusgroup discussions were conducted with 67 Thaipeople aged 60 and over. Transcripts werecontent analyzed resulting in theidentification of five dimensions ofwell-being: harmony, interdependence,acceptance, respect and enjoyment. Whencompared to research in the United States, someof the dimensions of psychological well-beingwere distinct while others were overlapping. Implications are discussed in relation to thedevelopment of culturally-relevant measures ofwell-being.

Psycho-oncologic interventions to reduce distress in cancer patients: a meta-analysis of controlled clinical studies published in People's Republic of China.

This study aimed to summarize the current result of controlled clinical studies published in China and analyzed the effect of psycho‐oncologic interventions on distress of cancer patients.

Managerial competence of first‐line nurse managers: A concept analysis

A variety of terms are used interchangeably to define managerial competence of first-line nurse managers. This has resulted in a degree of ambiguity in the way managerial competence is described. The aim of this concept analysis is to clarify what is meant by managerial competence of first-line nurse managers internationally, what attributes signify it, and what its antecedents and consequences are. The Walker and Avant concept analysis approach was applied. The attributes of managerial competence include developing self, planning, organizing, leading, managing legal and ethical issues, and delivering health care. Antecedents to managerial competence include internal and external factors. Consequences include nurse performances, nurse and patient outcomes, intention to stay of nurses, and nurse and patient satisfaction. This analysis helps first-line nurse managers to understand the concept and determine where the responsibility lies in establishing a definition of managerial competence. It is recommended that middle and top managers should be aware of the internal and external factors as antecedents of the concept. Further research is needed to illuminate the attributes of managerial competence in relation to antecedents and the potential effect upon the consequences, and the need to establish managerial competence evaluation.

Patient Readiness to Exercise After Cardiac Surgery: Development of the Readiness to Change Exercise Questionnaire.

Background:Readiness to change plays a significant role in patient adherence to an exercise regimen; thus, accurate assessment of readiness to change is necessary to direct interventions. To date, an accurate scale for measuring readiness to exercise after cardiac surgery is not available. Objectives:The purpose of this study was to develop the Readiness to Change Exercise Questionnaire for use among Thai cardiac surgery patients and to evaluate its psychometric properties. Methods:The Readiness to Change Exercise Questionnaire was developed based on the Transtheoretical Model, a comprehensive literature review, and input from experts and cardiac surgery patients. Participants were 533 patients who had undergone cardiac surgery within the previous 3 months. The study was conducted in 7 hospitals in 4 geographical regions of Thailand. Results:Confirmatory factor analysis showed satisfactory goodness of fit for the 13-item scale. The analysis supported a 4-factor structure corresponding to 4 readiness stages: precontemplation, contemplation, preparation, and action. Cronbach’s &agr; coefficients were .68 for precontemplation, .75 for contemplation, .72 for preparation, and .75 for action. Conclusions:The scale was found to be a valid and reliable instrument for the determination of patient readiness to exercise after cardiac surgery. However, further testing of the scale is needed to confirm its concurrent and predictive validity.

The effect of self-efficacy enhancement program on medication adherence among post-acute myocardial infarction

AIM AND BACKGROUND Studies have reported that adherence to medications after hospital discharge for myocardial infarction is poor with about 12% to 20% of patients discontinue their medications six months after discharge. This study aimed to examine the effect of self-efficacy enhancement program on medication adherence in post-acute myocardial infarction patients. METHODS A total 44 patient with post-acute myocardial infarction were recruited from the in-patient department, Police General Hospital. The participants were random assigned into control group and experimental group. The control group received conventional care while the experimental group attended a four-week self-efficacy enhancement program, which included motivation, skill practice, and monitoring skills. The mean self-efficacy score between groups was assessed. The pill count was used to measure medication adherence. Correlations between self-efficacy and medication adherence were examined. Data were analyzed using descriptive statistic, Pearsons correlation, and t-test. RESULTS The mean score on medication adherence of the experiment group who attended the self-efficacy enhancement program was significantly greater than the control group (t=-2.77; df=21; p=0.01). The mean scores of self-efficacy between the experimental and control group were 35.73 (SD=4.11) and 35.41 (SD=3.78). The correlations between self-efficacy and medication adherence were significantly (r=1.00, p=0.00). CONCLUSION The effectiveness of self-efficacy enhancement program was effective in improving medication adherence in Thai post-acute myocardial infarction.

The Lived Experiences of Becoming First line Nurse Managers: A Phenomenological Study

Background: Designated roles of first-line nurse managers (FLNMs) are very complex, this study aimed to develop a deeper understanding of their meaningful lived experiences. Materials and Methods: This study employed a phenomenological study using semi-structured interviews with FLNMs (n = 7) at the General Hospital of Belitung, Indonesia. The data analysis was thematic. Results: Four major themes were identified from the analysis of textual data: Feeling extraordinary, the inability to do, desire to leave the unit, and influenced by work motivation. The findings of this study revealed the positive and negative experiences of becoming FLNMs. The positive experiences were related to the feeling challenged and extraordinary to deal with many roles in management and leadership. The negative experiences included personal conflict related to the desire to leave the unit, and feeling unable to manage. However, the works of FLNMs were influenced by internal and external motivation. Conclusions: This study better informs nurse executives to develop competence and performance of FLNMs, and keep their motivation by revising performance appraisal system.

Nursing students plan after graduation: A qualitative study

BACKGROUND: Identifying nursing students’ plan after graduation is necessary to maintain the profession in line with their nursing education. This study was conducted to explore the career plans of diploma nursing students after graduation and factors influencing their plans. MATERIALS AND METHODS: This was a qualitative descriptive study using focus group discussion, conducted in Academy of Nursing of Belitung, Indonesia. Twenty diploma nursing students at the beginning of their 1st year of study were recruited. Data were analyzed using content analysis model. RESULTS: The plan of diploma nursing students after graduation: becoming a civil servant and its influencing factors (fixed and higher salary, fair remuneration and incentives, and retirement fund); becoming a bedside nurse and its influencing factors (helping others and gaining experiences); and continuing higher education in nursing and its influencing factors (recognition as professional nurse, financial support, family responsibilities, and location of nursing schools). CONCLUSION: It is suggested that nurse educators should change the mindset of the students not to focus only becoming a civil servant, and the government should open bachelor program in nursing in Belitung and provide educational support for those who would like to continue studying nursing.

Factors contributing to managerial competence of first‐line nurse managers: A systematic review

AIMS To determine the factors contributing to managerial competence of first-line nurse managers. BACKGROUND Understanding factors affecting managerial competence of nurse managers remains important to increase the performance of organizations; however, there is sparse research examining factors that influence managerial competence of first-line nurse managers. DESIGN Systematic review. DATA SOURCES The search strategy was conducted from April to July 2017 that included 6 electronic databases: Science Direct, PROQUEST Dissertations and Theses, MEDLINE, CINAHL, EMBASE, and Google Scholar for the years 2000 to 2017 with full text in English. Quantitative and qualitative research papers that examined relationships among managerial competence and antecedent factors were included. REVIEW METHODS Quality assessment, data extractions, and analysis were completed on all included studies. Content analysis was used to categorize factors into themes. RESULTS Eighteen influencing factors were examined and categorized into 3 themes-organizational factors, characteristics and personality traits of individual managers, and role factors. CONCLUSION Findings suggest that managerial competence of first-line nurse managers is multifactorial. Further research is needed to develop strategies to develop managerial competence of first-line nurse managers.