RESEARCH ARTICLE Open Access
Experiences of reduced work hours for
nurses and assistant nurses at a surgical
department: a qualitative study
Kristina Gyllensten1* , Gunnar Andersson2 and Helena Muller2
Abstract
Background: There is a shortage of registered nurses in the European Union (EU), and job dissatisfaction and perceived
high work–family conflict have been identified as causes of nursing staff turnover. Reducing work hours is an organisational
intervention that could have a positive effect on nurses’ and assistant nurses’ job satisfaction, work–life balance, and
willingness to stay in the job. An orthopaedic surgery department at a large hospital in Sweden introduced reduced
work hours for nurses and assistant nurses in order to improve the working situation. The aim of the study was to investigate
the experiences of reduced work hours and no lunch breaks among nurses and assistant nurses at an orthopaedic surgery
department at a hospital in Sweden, with a particular focus on recovery and psychosocial working environment.
Methods: A qualitative design was used in the study. Eleven nurses and assistant nurses working at the particular orthopaedic
department took part in the study, and semi-structured interviews were used to collect data. The interviews were analysed by
interpretative phenomenological analysis.
Results: Four main themes were developed in the analysis of the data: A more sustainable working situation, Improved
work–life balance, Consequences of being part of a project, and Improved quality of care. Each theme consisted of
subthemes.
Conclusions: Overall, reduced work hours appeared to have many, mainly positive, effects for the participants in both
work and home life.
Keywords: Reduced work hours, Nurses, Assistant nurses, Qualitative research, Psychosocial working environment,
Work-life balance
Background
There is a shortage of registered nurses in EU countries,
and this shortage is expected to worsen. Job dissatisfaction
and ill health are two important factors responsible for the
loss of practising nurses [1]. Perceived high work–family
conflict has also been identified as a cause of nursing staff
turnover, and not surprisingly, long working hours and
shift work have been found to be related to work–family
conflict among nurses [2, 3]. A large-scale study on work
shifts for European nurses found that long work hours
had a negative impact on fatigue, health and patient safety
[4]. Introduction of reduced work hours is an organisa-
tional intervention that could have a positive effect on
nurses’ and assistant nurses’ job satisfaction, work–life bal-
ance, and willingness to stay in the job.
The six-hour working day and reduced work hours are
hot topics that have received increasing attention in the
Swedish debate, with supporting arguments focusing on
decreasing unemployment and benefits for dual-earner
families and non-supporting arguments focusing on
reduction of competitiveness of companies and costs for
imp ...
Title The influence of working longer shift on nurses` quality of.docxherthalearmont
Title: The influence of working longer shift on nurses` quality of care
Introduction:
During the past three years, a series of studies have demonstrated the risks to patients and providers of long work hours in health care. Compared with nurses working shorter hours, nurses working greater than 12.5–13 consecutive hours report (1): a 1.9- to 3.3- fold increased odds of making an error in patient care1,2; (2) a significantly increased risk of suffering a needlestick injury, exposing them to an increased risk of acquiring hepatitis, HIV, or other bloodborne illnesses3; and (3) significant decrease in vigilance on the job. (9)
A number of healthcare organizations and state boards of nursing have adopted strategies to address concerns related to nurses’ shift lengths and fatigue and the connection with risks to patients and care providers. In 2003 the Accreditation Council for Graduate Medical Education (ACGME) began limiting shift length and duty hours of residents and fellows (ACGME, 2010), and ACGME published additional limitations in 2011 (ACGME, 2011). The Institute of Medicine (IOM) has also published guidelines and recommendations regarding nurses’ roles in the protection of patient safety and improved patient outcomes (IOM, 2004). (7)
Shift work is an inevitable part of many jobs which require 24 hour attendance and comprise working at unusual hours, especially at length shift . Because of potential hazards of length shift work on safety and health, there was an intensive debate on the “best compromise” shift system (Folkard, 1992). Shift length and kind of shift rotation (forward/backward rotation; quick and slow rotation) have been considered at length (Smith, Folkard, Tucker & Macdonald, 1998). Up to now, no unequivocal conclusion can be drawn with respect to shift length. One reason might be that mediating factors play an important role, such as length of recovery intervals between shifts, options for sleep recovery in these intervals, options to cope with fatigue within the shift, or personal and family activities, all of which contribute to cope with work stress (Folkard, 1992; Smith et al., 1998). (32)
Extended work shifts of twelve hours or longer are common and even popular with hospital staff nurses, but little is known about how such extended hours affect the care that patients receive or the wellbeing of nurses. Survey data from nurses in four states showed that more than 80 percent of the nurses were satisfied with scheduling practices at their hospital. However, as the proportion of hospital nurses working shifts of more than thirteen hours increased, patients’ dissatisfaction with care increased. Furthermore, nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. Extended shifts undermine nurses’ well-being, may result in expensive job turnover, and can negatively affect patien ...
This study explored the relationship between work stress, workload, and quality of life among 152 rehabilitation professionals in Taiwan. The results showed that for female respondents, factors like educational level, length of service, leisure time, expenses, work stress, and workload significantly impacted their quality of life. However, for male respondents, no factors showed a statistically significant relationship with their quality of life. The study suggests hospitals establish stress relief programs, evaluate workloads, provide training on stress management, and implement health promotion programs to improve employees' well-being.
Recording Recovery Opportunities at Work and Functional Fatigue after Work: T...Crimsonpublisherscojnh
Objectives: The importance of considering need for recovery after work and recovery opportunities at the workplace is relevant for occupational groups supporting clients in the workplace. Therefore, it is important that these concepts may be estimated with valid and reliable instruments within also a Swedish context. Thus, the aim of the study was to adapt the Need for Recovery (NFR) scale and the Recovery Opportunities (RO) scale to Swedish conditions and to assess the psychometric properties of the scales
COJ Nursing & Healthcare: Crimson Publishers
For more open access journals in Crimson Publishers
Please click on link: https://crimsonpublishers.com
For More Articles on COJ Nursing & Healthcare
Please click on: https://crimsonpublishers.com/cojnh/
The Impact of Burnout syndrome on Nurse Workers .docxrtodd33
The Impact of Burnout syndrome on Nurse Workers !1
The Impact of Burnout Syndrome on Psychosocial Wellbeing, Expected Outcomes, Self-efficacy,
Turnover, and Interest in Career of Nurse Workers.
Olajumoke Omiyale
Aspen University
Author Note
Essentials of Nursing Research N494
Dr. Keshea Britton
Date of Submission February 11, 2020
Burnout Among Nurses !2
Background
Burnout is a very common condition across the world and especially in the nursing
career. It's the reduction in the energy and zeal of nurses manifesting in form of being
emotionally exhausted, lacking motivation, feeling frustrated, fatigued, and low reaction time
which reduces individuals' output and work efficacy in general. Burnout has been strongly
attributed to the deficit in the number of healthcare professionals, a concern that goes way to be a
matter of global importance. The rapidly changing healthcare landscape that brings a paradigm
shift to increased demand for healthcare services in the world population has come with its
challenges. Although experts associate the change to improvement in the quality of life for which
people become capable of seeking healthcare services, the move has placed a lot of pressure on
not only the healthcare systems but particularly on the workforce (Mudallal, Othman, & Al
Hassan, 2017). However, governments have not moved at a similar pace to address these
pressures, leaving the mantle on the health institutions and professionals. To be specific, nurses,
as well as other healthcare providers, are left with a large number of patients to takes care of, a
number that keeps on increasing day after day, keeping them on the run all the time. The absolute
result of this healthcare environment is burning or wearing out, which without doubt minimizes
the efficacy of the nurse’s output.
The working environment for which the nurse staff doesn't match the care demand
culminated by poor leadership creates unattractive working conditions. Indeed, WHO reports
indicate that shortages of nurses would nationally and internally interfere with the efforts to
health and well being of the world population. Where staff shortage exists, human resources are
Burnout Among Nurses !3
overstretched, working conditions become poor and unbearable, work becomes increasingly
hazardous to the health of the nurse- they get no rest, become stressed, productivity decrease
with the poor patient outcome which add up to the trauma of the workers. They end up losing
interest in their job, become highly dissatisfied, burnout and increase the chances of quitting the
job. In return, the turnover of nurses affects the quality of healthcare services offered because of
a lack of expertise and increasing the workload burden on the remaining staff (Sobral, et. al,
2018). .
The Impact of Burnout syndrome on Nurse Workers !1
The Impact of Burnout Syndrome on Psychosocial Wellbeing, Expected Outcomes, Self-efficacy,
Turnover, and Interest in Career of Nurse Workers.
Olajumoke Omiyale
Aspen University
Author Note
Essentials of Nursing Research N494
Dr. Keshea Britton
Date of Submission February 11, 2020
Burnout Among Nurses !2
Background
Burnout is a very common condition across the world and especially in the nursing
career. It's the reduction in the energy and zeal of nurses manifesting in form of being
emotionally exhausted, lacking motivation, feeling frustrated, fatigued, and low reaction time
which reduces individuals' output and work efficacy in general. Burnout has been strongly
attributed to the deficit in the number of healthcare professionals, a concern that goes way to be a
matter of global importance. The rapidly changing healthcare landscape that brings a paradigm
shift to increased demand for healthcare services in the world population has come with its
challenges. Although experts associate the change to improvement in the quality of life for which
people become capable of seeking healthcare services, the move has placed a lot of pressure on
not only the healthcare systems but particularly on the workforce (Mudallal, Othman, & Al
Hassan, 2017). However, governments have not moved at a similar pace to address these
pressures, leaving the mantle on the health institutions and professionals. To be specific, nurses,
as well as other healthcare providers, are left with a large number of patients to takes care of, a
number that keeps on increasing day after day, keeping them on the run all the time. The absolute
result of this healthcare environment is burning or wearing out, which without doubt minimizes
the efficacy of the nurse’s output.
The working environment for which the nurse staff doesn't match the care demand
culminated by poor leadership creates unattractive working conditions. Indeed, WHO reports
indicate that shortages of nurses would nationally and internally interfere with the efforts to
health and well being of the world population. Where staff shortage exists, human resources are
Burnout Among Nurses !3
overstretched, working conditions become poor and unbearable, work becomes increasingly
hazardous to the health of the nurse- they get no rest, become stressed, productivity decrease
with the poor patient outcome which add up to the trauma of the workers. They end up losing
interest in their job, become highly dissatisfied, burnout and increase the chances of quitting the
job. In return, the turnover of nurses affects the quality of healthcare services offered because of
a lack of expertise and increasing the workload burden on the remaining staff (Sobral, et. al,
2018). .
Int. J. Environ. Res. Public Health 2013, 10, 2214-2240; doi1TatianaMajor22
Int. J. Environ. Res. Public Health 2013, 10, 2214-2240; doi:10.3390/ijerph10062214
International Journal of
Environmental Research and
Public Health
ISSN 1660-4601
www.mdpi.com/journal/ijerph
Review
Burnout in Relation to Specific Contributing Factors and Health
Outcomes among Nurses: A Systematic Review
Natasha Khamisa
1,2,
*, Karl Peltzer
3,4,5
and Brian Oldenburg
2,6
1
School of Health Sciences, Department of Public Health, Monash South Africa, 144 Peter Road,
Roodepoort, Johannesburg 1725, South Africa
2
Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne 3800,
Australia; E-Mail: [email protected]
3
Human Science Research Council, 134 Pretorius Street, Pretoria 0002, South Africa;
E-Mail: [email protected]
4
University of Limpopo, University Street, Turfloop, Sovenga, Polokwane 0727, South Africa
5
ASEAN Institute for Health Development, Mahidol University, Salaya 73170, Thailand
6
Monash Alfred Hospital Campus, Level 3 Burnet Tower, 89 Commercial Road, Melbourne 3004,
Australia
* Author to whom correspondence should be addressed; E-Mail: [email protected];
Tel.: +27-11-950-4450.
Received: 1 March 2013; in revised form: 16 May 2013 / Accepted: 24 May 2013 /
Published: 31 May 2013
Abstract: Nurses have been found to experience higher levels of stress-related burnout
compared to other health care professionals. Despite studies showing that both job
satisfaction and burnout are effects of exposure to stressful working environments, leading
to poor health among nurses, little is known about the causal nature and direction of these
relationships. The aim of this systematic review is to identify published research that has
formally investigated relationships between these variables. Six databases (including
CINAHL, COCHRANE, EMBASE, MEDLINE, PROQUEST and PsyINFO) were
searched for combinations of keywords, a manual search was conducted and an
independent reviewer was asked to cross validate all the electronically identified articles.
Of the eighty five articles that were identified from these databases, twenty one articles
were excluded based on exclusion criteria; hence, a total of seventy articles were included
in the study sample. The majority of identified studies exploring two and three way
relationships (n = 63) were conducted in developed countries. Existing research includes
OPEN ACCESS
Int. J. Environ. Res. Public Health 2013, 10 2215
predominantly cross-sectional studies (n = 68) with only a few longitudinal studies (n = 2);
hence, the evidence base for causality is still very limited. Despite minimal availability of
research concerning the small number of studies to investigate the relationships between
work-related stress, burnout, job satisfaction and the general health of nurses, this review
has identified some contradictory evidence for the role of job satisfaction. This emphasizes
the nee ...
The Effect of Working Hours on Health Care Expenditure in the United StatesNick Shepherd
This document discusses a study investigating the relationship between working hours and health care expenditure in the United States. It provides background on trends showing Americans working increasingly long hours without using vacation time. The study aims to quantify how working hours affects health and whether this correlates with higher health care costs. Literature is reviewed showing relationships between long work hours and poorer health outcomes like cardiovascular issues. Descriptive statistics are provided on data from the Current Population Survey used in the analysis.
In this assignment, students develop a 1,250-1,500 word change proposal paper that applies components worked on throughout the course, including a background, problem statement, purpose, PICOT question, literature search strategy, literature evaluation, change theory, implementation plan with outcomes, and potential barriers. The paper is to be formatted according to APA style guidelines and submitted to Turnitin to check for plagiarism. Feedback from previous assignments should be incorporated. Attached papers provide reference examples and should not be directly plagiarized.
Title The influence of working longer shift on nurses` quality of.docxherthalearmont
Title: The influence of working longer shift on nurses` quality of care
Introduction:
During the past three years, a series of studies have demonstrated the risks to patients and providers of long work hours in health care. Compared with nurses working shorter hours, nurses working greater than 12.5–13 consecutive hours report (1): a 1.9- to 3.3- fold increased odds of making an error in patient care1,2; (2) a significantly increased risk of suffering a needlestick injury, exposing them to an increased risk of acquiring hepatitis, HIV, or other bloodborne illnesses3; and (3) significant decrease in vigilance on the job. (9)
A number of healthcare organizations and state boards of nursing have adopted strategies to address concerns related to nurses’ shift lengths and fatigue and the connection with risks to patients and care providers. In 2003 the Accreditation Council for Graduate Medical Education (ACGME) began limiting shift length and duty hours of residents and fellows (ACGME, 2010), and ACGME published additional limitations in 2011 (ACGME, 2011). The Institute of Medicine (IOM) has also published guidelines and recommendations regarding nurses’ roles in the protection of patient safety and improved patient outcomes (IOM, 2004). (7)
Shift work is an inevitable part of many jobs which require 24 hour attendance and comprise working at unusual hours, especially at length shift . Because of potential hazards of length shift work on safety and health, there was an intensive debate on the “best compromise” shift system (Folkard, 1992). Shift length and kind of shift rotation (forward/backward rotation; quick and slow rotation) have been considered at length (Smith, Folkard, Tucker & Macdonald, 1998). Up to now, no unequivocal conclusion can be drawn with respect to shift length. One reason might be that mediating factors play an important role, such as length of recovery intervals between shifts, options for sleep recovery in these intervals, options to cope with fatigue within the shift, or personal and family activities, all of which contribute to cope with work stress (Folkard, 1992; Smith et al., 1998). (32)
Extended work shifts of twelve hours or longer are common and even popular with hospital staff nurses, but little is known about how such extended hours affect the care that patients receive or the wellbeing of nurses. Survey data from nurses in four states showed that more than 80 percent of the nurses were satisfied with scheduling practices at their hospital. However, as the proportion of hospital nurses working shifts of more than thirteen hours increased, patients’ dissatisfaction with care increased. Furthermore, nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. Extended shifts undermine nurses’ well-being, may result in expensive job turnover, and can negatively affect patien ...
This study explored the relationship between work stress, workload, and quality of life among 152 rehabilitation professionals in Taiwan. The results showed that for female respondents, factors like educational level, length of service, leisure time, expenses, work stress, and workload significantly impacted their quality of life. However, for male respondents, no factors showed a statistically significant relationship with their quality of life. The study suggests hospitals establish stress relief programs, evaluate workloads, provide training on stress management, and implement health promotion programs to improve employees' well-being.
Recording Recovery Opportunities at Work and Functional Fatigue after Work: T...Crimsonpublisherscojnh
Objectives: The importance of considering need for recovery after work and recovery opportunities at the workplace is relevant for occupational groups supporting clients in the workplace. Therefore, it is important that these concepts may be estimated with valid and reliable instruments within also a Swedish context. Thus, the aim of the study was to adapt the Need for Recovery (NFR) scale and the Recovery Opportunities (RO) scale to Swedish conditions and to assess the psychometric properties of the scales
COJ Nursing & Healthcare: Crimson Publishers
For more open access journals in Crimson Publishers
Please click on link: https://crimsonpublishers.com
For More Articles on COJ Nursing & Healthcare
Please click on: https://crimsonpublishers.com/cojnh/
The Impact of Burnout syndrome on Nurse Workers .docxrtodd33
The Impact of Burnout syndrome on Nurse Workers !1
The Impact of Burnout Syndrome on Psychosocial Wellbeing, Expected Outcomes, Self-efficacy,
Turnover, and Interest in Career of Nurse Workers.
Olajumoke Omiyale
Aspen University
Author Note
Essentials of Nursing Research N494
Dr. Keshea Britton
Date of Submission February 11, 2020
Burnout Among Nurses !2
Background
Burnout is a very common condition across the world and especially in the nursing
career. It's the reduction in the energy and zeal of nurses manifesting in form of being
emotionally exhausted, lacking motivation, feeling frustrated, fatigued, and low reaction time
which reduces individuals' output and work efficacy in general. Burnout has been strongly
attributed to the deficit in the number of healthcare professionals, a concern that goes way to be a
matter of global importance. The rapidly changing healthcare landscape that brings a paradigm
shift to increased demand for healthcare services in the world population has come with its
challenges. Although experts associate the change to improvement in the quality of life for which
people become capable of seeking healthcare services, the move has placed a lot of pressure on
not only the healthcare systems but particularly on the workforce (Mudallal, Othman, & Al
Hassan, 2017). However, governments have not moved at a similar pace to address these
pressures, leaving the mantle on the health institutions and professionals. To be specific, nurses,
as well as other healthcare providers, are left with a large number of patients to takes care of, a
number that keeps on increasing day after day, keeping them on the run all the time. The absolute
result of this healthcare environment is burning or wearing out, which without doubt minimizes
the efficacy of the nurse’s output.
The working environment for which the nurse staff doesn't match the care demand
culminated by poor leadership creates unattractive working conditions. Indeed, WHO reports
indicate that shortages of nurses would nationally and internally interfere with the efforts to
health and well being of the world population. Where staff shortage exists, human resources are
Burnout Among Nurses !3
overstretched, working conditions become poor and unbearable, work becomes increasingly
hazardous to the health of the nurse- they get no rest, become stressed, productivity decrease
with the poor patient outcome which add up to the trauma of the workers. They end up losing
interest in their job, become highly dissatisfied, burnout and increase the chances of quitting the
job. In return, the turnover of nurses affects the quality of healthcare services offered because of
a lack of expertise and increasing the workload burden on the remaining staff (Sobral, et. al,
2018). .
The Impact of Burnout syndrome on Nurse Workers !1
The Impact of Burnout Syndrome on Psychosocial Wellbeing, Expected Outcomes, Self-efficacy,
Turnover, and Interest in Career of Nurse Workers.
Olajumoke Omiyale
Aspen University
Author Note
Essentials of Nursing Research N494
Dr. Keshea Britton
Date of Submission February 11, 2020
Burnout Among Nurses !2
Background
Burnout is a very common condition across the world and especially in the nursing
career. It's the reduction in the energy and zeal of nurses manifesting in form of being
emotionally exhausted, lacking motivation, feeling frustrated, fatigued, and low reaction time
which reduces individuals' output and work efficacy in general. Burnout has been strongly
attributed to the deficit in the number of healthcare professionals, a concern that goes way to be a
matter of global importance. The rapidly changing healthcare landscape that brings a paradigm
shift to increased demand for healthcare services in the world population has come with its
challenges. Although experts associate the change to improvement in the quality of life for which
people become capable of seeking healthcare services, the move has placed a lot of pressure on
not only the healthcare systems but particularly on the workforce (Mudallal, Othman, & Al
Hassan, 2017). However, governments have not moved at a similar pace to address these
pressures, leaving the mantle on the health institutions and professionals. To be specific, nurses,
as well as other healthcare providers, are left with a large number of patients to takes care of, a
number that keeps on increasing day after day, keeping them on the run all the time. The absolute
result of this healthcare environment is burning or wearing out, which without doubt minimizes
the efficacy of the nurse’s output.
The working environment for which the nurse staff doesn't match the care demand
culminated by poor leadership creates unattractive working conditions. Indeed, WHO reports
indicate that shortages of nurses would nationally and internally interfere with the efforts to
health and well being of the world population. Where staff shortage exists, human resources are
Burnout Among Nurses !3
overstretched, working conditions become poor and unbearable, work becomes increasingly
hazardous to the health of the nurse- they get no rest, become stressed, productivity decrease
with the poor patient outcome which add up to the trauma of the workers. They end up losing
interest in their job, become highly dissatisfied, burnout and increase the chances of quitting the
job. In return, the turnover of nurses affects the quality of healthcare services offered because of
a lack of expertise and increasing the workload burden on the remaining staff (Sobral, et. al,
2018). .
Int. J. Environ. Res. Public Health 2013, 10, 2214-2240; doi1TatianaMajor22
Int. J. Environ. Res. Public Health 2013, 10, 2214-2240; doi:10.3390/ijerph10062214
International Journal of
Environmental Research and
Public Health
ISSN 1660-4601
www.mdpi.com/journal/ijerph
Review
Burnout in Relation to Specific Contributing Factors and Health
Outcomes among Nurses: A Systematic Review
Natasha Khamisa
1,2,
*, Karl Peltzer
3,4,5
and Brian Oldenburg
2,6
1
School of Health Sciences, Department of Public Health, Monash South Africa, 144 Peter Road,
Roodepoort, Johannesburg 1725, South Africa
2
Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne 3800,
Australia; E-Mail: [email protected]
3
Human Science Research Council, 134 Pretorius Street, Pretoria 0002, South Africa;
E-Mail: [email protected]
4
University of Limpopo, University Street, Turfloop, Sovenga, Polokwane 0727, South Africa
5
ASEAN Institute for Health Development, Mahidol University, Salaya 73170, Thailand
6
Monash Alfred Hospital Campus, Level 3 Burnet Tower, 89 Commercial Road, Melbourne 3004,
Australia
* Author to whom correspondence should be addressed; E-Mail: [email protected];
Tel.: +27-11-950-4450.
Received: 1 March 2013; in revised form: 16 May 2013 / Accepted: 24 May 2013 /
Published: 31 May 2013
Abstract: Nurses have been found to experience higher levels of stress-related burnout
compared to other health care professionals. Despite studies showing that both job
satisfaction and burnout are effects of exposure to stressful working environments, leading
to poor health among nurses, little is known about the causal nature and direction of these
relationships. The aim of this systematic review is to identify published research that has
formally investigated relationships between these variables. Six databases (including
CINAHL, COCHRANE, EMBASE, MEDLINE, PROQUEST and PsyINFO) were
searched for combinations of keywords, a manual search was conducted and an
independent reviewer was asked to cross validate all the electronically identified articles.
Of the eighty five articles that were identified from these databases, twenty one articles
were excluded based on exclusion criteria; hence, a total of seventy articles were included
in the study sample. The majority of identified studies exploring two and three way
relationships (n = 63) were conducted in developed countries. Existing research includes
OPEN ACCESS
Int. J. Environ. Res. Public Health 2013, 10 2215
predominantly cross-sectional studies (n = 68) with only a few longitudinal studies (n = 2);
hence, the evidence base for causality is still very limited. Despite minimal availability of
research concerning the small number of studies to investigate the relationships between
work-related stress, burnout, job satisfaction and the general health of nurses, this review
has identified some contradictory evidence for the role of job satisfaction. This emphasizes
the nee ...
The Effect of Working Hours on Health Care Expenditure in the United StatesNick Shepherd
This document discusses a study investigating the relationship between working hours and health care expenditure in the United States. It provides background on trends showing Americans working increasingly long hours without using vacation time. The study aims to quantify how working hours affects health and whether this correlates with higher health care costs. Literature is reviewed showing relationships between long work hours and poorer health outcomes like cardiovascular issues. Descriptive statistics are provided on data from the Current Population Survey used in the analysis.
In this assignment, students develop a 1,250-1,500 word change proposal paper that applies components worked on throughout the course, including a background, problem statement, purpose, PICOT question, literature search strategy, literature evaluation, change theory, implementation plan with outcomes, and potential barriers. The paper is to be formatted according to APA style guidelines and submitted to Turnitin to check for plagiarism. Feedback from previous assignments should be incorporated. Attached papers provide reference examples and should not be directly plagiarized.
Brough et al perspectives on the effects and mechanisms of CST a qualitative ...Nicola Brough
This document summarizes a qualitative study on the effects and mechanisms of craniosacral therapy according to users' views. 29 participants were interviewed about their experiences with craniosacral therapy. Most participants reported improvements in at least two dimensions of holistic wellbeing: body, mind and spirit. Experiences during therapy included altered perceptual states and specific sensations and emotions. Participants emphasized the importance of the therapeutic relationship. The emerging theory from the study suggests that the trusting relationship in craniosacral therapy allows clients to experience altered states of awareness, which facilitates a new understanding of the interrelatedness of body, mind and spirit and an enhanced ability to care for oneself and manage health problems.
Stress and Healthcare Workers Productivity at Lexington Medical .docxcpatriciarpatricia
Stress and Healthcare Workers Productivity at Lexington Medical Center
ABSTRACT
The research proposal aim at assessing the effect of workplace stress on workers productivity at Lexington Medical Center. The objective of the research is to assess worker productivity, the stress level among health workers, and the extent to which their productivity and performance is related to stress levels. The research survey will be a cross section and it will involve 120 participants (about 20% of the total population) and it will be conducted through convenience sampling techniques and stratified sampling. The data will be collected using questionnaire and descriptive statistical regression analysis will be used for data analysis. Before the actual data collection, there will be pilot study to determine reliability of the
research process. At this stage, the research will include expert opinion to enhance validity of the research.
This abstract did not give a background and summary of your study, and your expected outcome
Keywords:Employee productivity/ job performance, work place stress/occupational stress, doctors, nurses, medical attendant Lexington Medical Center.
Table of Contents
Why do you have a background and Statement of the Problem? The background can be covered in the statement and description of the problem.
1CHAPTER ONE
11.0INTRODUCTION
11.1 Background to the Research Problem
31.2 Statement of the Research Problem
31.3 Objectives of the Study
31.3.1General Objective
41.3.2 Specific Objectives
41.4. Research Questions
Why do you have a General and a Specific Objectives and Research Question. Please read the textbook or my powertpoint and understand it. Also my dissertation..
41.4.1 General Research Question
41.4.2 Specific Research Questions
41.5 Relevance of the Research
51.6 Organization of the Dissertation (Why disseration? Disseration is totally different from a Research Proposal
51.7. Limitations
6CHAPTER TWO
62.0 LITERATURE REVIEW
62.1 Overview
62.2 Conceptual Definitions
72.2.1 Work Place Stress
72.2.2 Employee Performance
82.3. Theoretical Literature Review
82.3.1 Employees Performance Management
82.3.2 Stress at Workplace
10Work Stress and Employees Performance
10Theories of Work Stress
10The Job Demands-Control Theory (JD-C)
11The Role Theory
11Empirical Literature Review
12Assessing Employee Performance
132.5.3 Relationship between work Stresses and Employee Performance
13Research Gap Identified
142.9 Statement of Hypotheses
15CHAPTER THREE
153.0 RESEARCH METHODOLOGY
153.1 Overview
153.2 Research Design
153.3 Study Population
153.4 Area of the Research
163.5.1 Sample Size
173.5.2 Sampling Procedure
183.6. Variables and Measurements
193.7 Methods and Instrument Used for Data Collection
193.8. Data Processing and Analysis
21CHAPTER FOUR
214.0 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
214.1 Summary
22References
CHAPTER ONE
1.0 INTRODUCTION (Omit the numbers. LOOK AT MY DISSERATION)
1.1 Background You do not need to put backgr.
Stress and Healthcare Workers Productivity at Lexington Medical blazelaj2
Stress and Healthcare Workers Productivity at Lexington Medical Center
Veronica N Cornell
Claflin University
ABSTRACT
[BY1]
The research proposal aim at assessing the effect of workplace stress on workers productivity at Lexington Medical Center. The objective of the research is to assess worker productivity, the stress level among health workers, and the extent to which their productivity and performance is related to stress levels. The research survey will be a cross section and it will involve 120 participants (about 20% of the total population) and it will be conducted through convenience sampling techniques and stratified sampling. The data will be collected using questionnaire and descriptive statistical regression analysis will be used for data analysis. Before the actual data collection, there will be pilot study to determine reliability of the
[BY2]
research process. At this stage, the research will include expert opinion to enhance validity of the research.
This abstract did not give a background and summary of your study, and your expected outcome
Keywords:
Employee productivity/ job performance, work place stress/occupational stress, doctors, nurses, medical attendant Lexington Medical Center.
Table of Contents
[BY3]
Why do you have a background and Statement of the Problem? The background can be covered in the statement and description of the problem.
CHAPTER ONE............................................................................................................ 1
1.0 INTRODUCTION.. 1
1.1 Background to the Research Problem.. 1
1.2 Statement of the Research Problem.. 3
1.3 Objectives of the Study. 3
1.3.1General Objective. 3
1.3.2 Specific Objectives. 4
1.4. Research Questions. 4
Why do you have a General and a Specific Objectives and Research Question. Please read the textbook or my powertpoint and understand it. Also my dissertation..
1.4.1 General Research Question. 4
1.4.2 Specific Research Questions. 4
1.5 Relevance of the Research. 4
1.6 Organization of the Dissertation (Why disseration? Disseration is totally different from a Research Proposal 5
1.7. Limitations. 5
CHAPTER TWO.. 6
2.0 LITERATURE REVIEW... 6
2.1 Overview.. 6
2.2 Conceptual Definitions. 6
2.2.1 Work Place Stress. 7
2.2.2 Employee Performance. 7
2.3. Theoretical Literature Review.. 8
2.3.1 Employees Performance Management 8
2.3.2 Stress at Workplace. 8
Work Stress and Employees Performance. 10
Theories of Work Stress. 10
The Job Demands-Control Theory (JD-C) 10
The Role Theory. 11
Empirical Literature Review.. 11
Assessing Employee Performance. 12
2.5.3 Relationship between work Stresses and Employee Performance. 13
Research Gap Identified. 13
2.9 Statement of Hypotheses. 14
CHAPTER THREE.. 15
3.0 RESEARCH METHODOLOGY.. 15
3.1 Overview.. 15
3.2 Research Design. 15
3.3 Study Population. 15
3.4 Area of the Research. 15
3.5.1 Sample Size. 16
3.5.2 Sampling Procedure. 17
3.6. Variables and Measurements ...
JONAVolume 47, Number 1, pp 41-49Copyright B 2017 Wolters .docxvrickens
JONA
Volume 47, Number 1, pp 41-49
Copyright B 2017 Wolters Kluwer Health, Inc. All rights reserved.
T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N
The Effect of Reported Sleep,
Perceived Fatigue, and Sleepiness on
Cognitive Performance in a Sample of
Emergency Nurses
Lisa A. Wolf, PhD, RN, CEN, FAEN
Cydne Perhats, MPH
Altair Delao, MPH
Zoran Martinovich, PhD
OBJECTIVE: The aim of this study is to explore
the relationship between reported sleep, perceived
fatigue and sleepiness, and cognitive performance.
BACKGROUND: Although evidence suggests that
fatigue and sleepiness affect the provision of care in
inpatient units, there is a lack of research on the sleep
patterns of emergency nurses and the effects of dis-
turbed sleep and fatigue on their cognitive abilities
and susceptibility to medical errors.
METHODS: A quantitative correlational design was
used in this study; in each of 7 different statistical models,
zero-order relationships between predictors and the
dependent variable were examined with appropriate
inferential tests.
RESULTS: Participants reported high levels of
sleepiness and chronic fatigue that impeded full
functioning both at work and at home.
CONCLUSIONS: Although high levels of self-reported
fatigue did not show any effects on cognitive function,
other factors in the environment may contribute to
delayed, missed, or inappropriate care. Further research
is indicated.
Studies of worker fatigue in the military and com-
mercial trucking industries1,2 suggest that long hours,
especially extending into overnight, can be hazardous
in terms of the potential for errors due to sleepiness
and reduced vigilance. Medical providers, both nurses
and physicians, are at risk because of the need for
around-the-clock coverage and the number and type
of decisions they must make in a given time span; in
1989, the Bell Commission Report cited sleep depri-
vation in medical house officers as a major contrib-
utor to the 1984 death of Libby Zion, an 18-year-old
who died at New York Hospital, leading to a restruc-
turing of the hours involved in medical residencies.3
The long (up to 36 hour) shifts of the medical resi-
dents in charge of her care and the consequences of
their fatigue on the decisions that were made were
cited as factors in her death. As a result of their inves-
tigation of the case, the Bell commission recommen-
ded limiting the work hours of medical residents to
less than 80 hours a week and no more than 24 hours
in a row, and subsequent research has led to similar
recommendations for the nursing workforce.4,5
Emergency care settings are chaotic environ-
ments, where there is high patient turnover, constantly
changing priorities and frequent changes in patient
condition. High demand work settings are associated
with increased fatigue, which can impair nurses_ at-
tentiveness and ability not only to recognize potential
errors they might commit but also to recognize and
mitigate the errors of others, inc ...
Physician Burnout & Mindfulness Training: An Approach That Works By Floyd ArthurFloyd Arthur
This document discusses physician burnout and how mindfulness training can help address it. It notes that over half of physicians experience burnout symptoms like emotional exhaustion and dissatisfaction with work-life balance. Common causes include too much bureaucracy, long work hours, and feeling like "just a cog in the wheel." Burnout has negative impacts like increased risk of mistakes, substance abuse, and leaving the profession. The document then discusses how mindfulness meditation through training can significantly reduce stress and burnout symptoms. It provides details on the positive effects of both intensive long-term mindfulness training programs and abbreviated shorter mindfulness courses for physicians.
This study examined the relationship between stress responses and lifestyle factors like sleep, eating, and overtime work among 3,017 Japanese workers. The results showed:
1) 8.4% of participants were in the stress group. Stress responses were associated with sleeping less than 6 hours among women, and working over 45 hours of overtime among men.
2) Eating at night was associated with stress responses in the initial univariate analysis for both men and women. However, this relationship did not remain significant in the multivariate analysis.
3) Overall, stress responses were related to lifestyle factors for women but not for men. Short sleep was linked to stress for women, while long work hours were linked to stress for men.
A Corporate Wellness Program And Nursing Home Employees HealthValerie Felton
This study evaluated the impact of a corporate wellness program across 18 nursing homes. The nursing homes were categorized based on the level of wellness programming offered: well-developed, emerging, or no program. Surveys were administered to employees to assess health behaviors, working conditions, and beliefs. There were no significant differences found between programming levels for most health outcomes. Workers in facilities with well-developed programs had a slightly lower average BMI and were less likely to exercise regularly or be non-smokers. The authors conclude the program had modest influence on employee health and that more supportive approaches are needed.
Evaluation of Research Essay Discussion.pdfsdfghj21
This document provides guidelines for an assignment to evaluate empirical research related to a PICOT question. Students are instructed to write a 1,250-1,500 word paper evaluating literature on their PICOT question by addressing study conclusions, merits, and limitations. Feedback from instructors is also discussed, noting a revised PICOT question focusing more specifically on patient outcomes and data collection time period.
Objective: The aim of the study was to identify level of stress among nurses according to their job status. Background: Stress is highly associated with nursing profession. This stress is caused by several factors both personal and organizational such as educational level, gender, nature of work environment and work overload etc. These factors directly or indirectly expose nurses to a considerable level of stress. If a nurse works at two places, their stress level will predictably be much higher than that of those who work at a single place. Methodology: Quantitative analytical cross-sectional study design was applied in a private tertiary care hospital at Peshawar, Pakistan. Study population included all nurses working in the mentioned hospital. Universal sampling technique was used for double jobber nurses, while convenient sampling technique was used for single jobber nurses. An adopted questionnaire was used for data collection. Chi-square test was applied to analyze the data. Result: Among double jobber nurses, 23.33% had severe, 63.34% had moderate, and 13.33% had mild level of stress. On the other hand, there was no severe level of stress among single jobbers; only 20% had moderate and 80% had mild level of stress. Conclusion: The current study identified that level of stress was higher in double jobber nurses as compared to single jobber nurses. The study would have been more generalizable if more tertiary care hospitals were included for data collection.
This document discusses the debate around nurses working 12-hour shifts versus 8-hour shifts. Research is being conducted to understand the impact of shift length on staff, patient safety, and job satisfaction. Some nurses prefer 12-hour shifts for more days off, while others argue it can affect quality of care. The goal is for employers to offer a choice between 8- and 12-hour shifts to increase job satisfaction and reduce fatigue, while balancing staffing needs. A survey was conducted to evaluate readiness for implementing a choice in shift lengths.
This summary provides an overview of a paper presented by Dr. Jonathan Passmore to the Danish Psychological Association in 2009 on the topic of mindfulness at work and in coaching:
1) The paper discusses how mindfulness can benefit both individuals and organizations by improving factors like stress, well-being, performance, and safety culture.
2) Research shows that mindfulness enhances psychological well-being, creativity, emotional intelligence, and learning. It also improves physiological measures like blood pressure.
3) The paper argues that introducing mindfulness practices can help create "truly healthy organizations" by fostering learning, communication, and a sense of community.
This document outlines a proposed study to compare stress levels among nurses working in psychiatric versus multispecialty hospitals in Bangalore, India. It notes that nurses experience various workplace stressors and are at high risk for stress and burnout. The study aims to identify the sources and extent of stress in these settings to inform strategies for supporting nurses' health and reducing absenteeism. It will utilize validated scales to assess stress levels and correlates among nurses to determine if they differ between hospital types. The results could help hospitals acknowledge and address chronic workplace stress impacting nurses.
This study examined aspects of sustainability among Swiss psychiatrists by assessing levels of cooperation, job satisfaction, and burnout. The researchers surveyed 352 psychiatrists. They found that cooperation was highest with general practitioners and lowest with community mental health providers. Overall job satisfaction was assessed as high, while burnout rates were below concerning thresholds. Both job satisfaction and burnout correlated inversely, with higher satisfaction associated with lower burnout. Cooperation was positively associated with job satisfaction and inversely with burnout. The study concludes that fostering sustainability in outpatient psychiatric care requires considering personal, organizational, and supportive factors that can influence cooperation, satisfaction, and burnout.
JOB SATISFATION AND NURSE PATIENT RATIO24Table of Contents.docxchristiandean12115
This document provides an overview of a research study that examines the relationship between nurse job satisfaction, nurse-patient ratios, and nurse fatigue. It includes an introduction that outlines the background, problem statement, purpose, significance and research questions. It also presents hypotheses and a brief literature review. The methodology chapter describes the research design, sample, instruments and data analysis plan. Results, discussion and conclusions chapters are also outlined. The document provides a framework to guide the proposed empirical study on the key factors relating to nurse fatigue.
Running head: LITERATURE REVIEW 13
LITERATURE REVIEW 8
Literature Review: ICU Quiet Time
Ese Noskhare
Walden University
Essentials of Evidence-Based Practice
NURS-6052-45
Running head: LITERATURE REVIEW 8
Introduction
Literature review represents very integral aspects of the research process. It is aimed at deriving out the current knowledge on the selected topic including the common patterns, contradictions, and gaps and, as a result, aid in determining what needs to be done by future researchers. In the present paper, the aim is to analyze and synthesize studies that have been conducted focusing on ICU Quiet time and more particularly, the effects of strict enforcement of scheduled hours of rest time on multiple incidences of delirium in adult critical-care patients in the ICU.
History
The onset of ICU Quiet time has been reported as dating back in the 1960s. It originated in the North America and, in particular, Quebec, Canada. It took place as a result of the natural continuation of creativity and innovations that occurred in Quebec. The period saw the introduction of the Hospital Insurance and Diagnostic Services Act, which brought rise to the concept and practice of public health insurance. This triggered the implementation of varied infrastructural projects in the health care. It is in the course of these changes that quiet time in ICUs was introduced with the aim of speeding up the healing of the patients. This practice prevails even in the modern day times.
Current Evidence
For a considerable period, research on ICU Quiet time has been rampant. Most of the frequent cited studies include Gardner, Collins, Osborne, Henderson, and Eastwood (2008), Maidl, Leske, and Garcia (2013), Olson, Borel, Laskowitz, Moore, and McConnell (2001), Richardson, Thompson, Coghill, Chambers, and Turnock (2009), Taylor (2008) and Weinhouse et al. (2009).
In their study, Gardner, Collins, Osborne, Henderson, and Eastwood (2008) used a sample of 299 participants. The sample received a scheduled quiet time intervention. In the process, the researchers evaluated the levels of noise, the rest of the inpatients, their sleep behaviors, and their well-being. It was concluded that the majority of the ICU patients are not usually concerned with noise. However, they often prefer a period in which they are not exposed to noise. The researchers also identified that nurses also see a great value in ICU Quiet time. In another study by Maidl, Leske, and Garcia (2013), the researchers carried out a set of non-randomized, uncontrolled quiet time trials in ICUs. The intervention involved a reduction of the environmental stressors and enhanced patient rest prior to the onset of the trials. It was determined that ICU patients often prefer quiet time. Also, according to the researchers, the nursing practitioners that work in the ICUs also value quiet time as they are allowed to chart and, as a result, reduce their levels of stress. In the process, better care is .
Respond to the Main post bellow, in one or more of the follomickietanger
Respond to the Main post bellow, in one or more of the following ways:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
INITIAL POST
An Intervention Program to Promote Health-Related Physical Fitness in Nurses
This quantitative, quasi-experimental study conducted by Yaun et al. (2009) aimed to determine the effects of an exercise intervention on nurses’ health-related physical fitness. The researchers also expressed an explicit interest in the relationship between physical fitness and the incidence of musculoskeletal disorders. Taiwanese nurses from five different units volunteered to be part of the study. The participants were divided into two groups with 45 nurses in the experimental group and 45 nurses in the control group. There was no randomization, but all the participants gave written informed consent (Yaun et al., 2009).
Internal Validity
According to Polit and Beck (2017), internal validity pertains to the empirical relationship between the independent variable and the final results. Researchers must establish that the intended cause created the effect, and that it was not influenced by other variables (Polit & Beck, 2017). After all, correlation does not equal causation, and an astute researcher will adeptly identify and control convoluting variables. Further, Andrade (2018) asserts that internal validity assesses whether the design of the study, the conduct of the researchers, and the analysis of the results answer the research question without bias (Andrade, 2018).
Consequently, the research conducted by Yaun et al. did have some issues that negatively impacted the internal validity of their research. Firstly, convoluting variables were not adequately controlled. The exclusion criteria consisted of cardiovascular disease, diabetes, hypertension, renal disease, pulmonary disease, severe musculoskeletal aches, and pregnancy. However, other significant variables such as age, gender, marital status, educational level, or other medical issues. It is worth noting that the diet and exercise habits of the participants were not limited by the researchers.
Moreover, the nurses in the experimental group worked a fixed schedule whereas nurses in the control group worked alternating shifts. Secondly, the lack of randomization coupled w ...
According to the textbook, the Federal Disaster Assistance Act of 19.docxronak56
According to the textbook, the Federal Disaster Assistance Act of 1950 (P.L. 81-875) defined the roles and responsibilities during natural disasters. Once the president issued a disaster declaration, federal relief resources could flow to the affected areas for response and recovery. The president would then delegate administrative control of relief efforts to the Housing and Home Finance Administration. This law also instituted the federal role in natural disasters as a supportive role, while instituting primary responsibility for disaster response and recovery with local and state governments. How had this changed by 1978? Why did it change? Do you agree with the change? Why, or why not?
300 WORDS
APA FORMAT
.
According to the Council on Social Work Education, Competency 5 Eng.docxronak56
According to the Council on Social Work Education, Competency 5: Engage in Policy Practice:
Social workers understand that human rights and social justice, as well as social welfare and services, are mediated by policy and its implementation at the federal, state, and local levels. Social workers understand the history and current structures of social policies and services, the role of policy in service delivery, and the role of practice in policy development. Social workers understand their role in policy development and implementation within their practice settings at the micro, mezzo, and macro levels and they actively engage in policy practice to effect change within those settings. Social workers recognize and understand the historical, social, cultural, economic, organizational, environmental, and global influences that affect social policy. They are also knowledgeable about policy formulation, analysis, implementation, and evaluation. Social workers:
Identify social policy at the local, state, and federal level that impacts well-being, service delivery, and access to social services;
Assess how social welfare and economic policies impact the delivery of and access to social services;
Apply critical thinking to analyze, formulate, and advocate for policies that advance human rights and social, economic, and environmental justice.
This assignment is intended to help students demonstrate the behavioral components of this competency in their field education.
To prepare: Working with your field instructor, identify, evaluate, and discuss policies established by the local, state, and federal government (within the last five years) that affect the day to day operations of the field placement agency.
The Assignment (1-2 pages):
Describe the policies and their impact on the field agency.
Propose specific recommendations regarding how you, as a social work intern, and the agency can advocate for policies pertaining to advancing social justice for the agency and the clients it serves.
.
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This document summarizes a qualitative study on the effects and mechanisms of craniosacral therapy according to users' views. 29 participants were interviewed about their experiences with craniosacral therapy. Most participants reported improvements in at least two dimensions of holistic wellbeing: body, mind and spirit. Experiences during therapy included altered perceptual states and specific sensations and emotions. Participants emphasized the importance of the therapeutic relationship. The emerging theory from the study suggests that the trusting relationship in craniosacral therapy allows clients to experience altered states of awareness, which facilitates a new understanding of the interrelatedness of body, mind and spirit and an enhanced ability to care for oneself and manage health problems.
Stress and Healthcare Workers Productivity at Lexington Medical .docxcpatriciarpatricia
Stress and Healthcare Workers Productivity at Lexington Medical Center
ABSTRACT
The research proposal aim at assessing the effect of workplace stress on workers productivity at Lexington Medical Center. The objective of the research is to assess worker productivity, the stress level among health workers, and the extent to which their productivity and performance is related to stress levels. The research survey will be a cross section and it will involve 120 participants (about 20% of the total population) and it will be conducted through convenience sampling techniques and stratified sampling. The data will be collected using questionnaire and descriptive statistical regression analysis will be used for data analysis. Before the actual data collection, there will be pilot study to determine reliability of the
research process. At this stage, the research will include expert opinion to enhance validity of the research.
This abstract did not give a background and summary of your study, and your expected outcome
Keywords:Employee productivity/ job performance, work place stress/occupational stress, doctors, nurses, medical attendant Lexington Medical Center.
Table of Contents
Why do you have a background and Statement of the Problem? The background can be covered in the statement and description of the problem.
1CHAPTER ONE
11.0INTRODUCTION
11.1 Background to the Research Problem
31.2 Statement of the Research Problem
31.3 Objectives of the Study
31.3.1General Objective
41.3.2 Specific Objectives
41.4. Research Questions
Why do you have a General and a Specific Objectives and Research Question. Please read the textbook or my powertpoint and understand it. Also my dissertation..
41.4.1 General Research Question
41.4.2 Specific Research Questions
41.5 Relevance of the Research
51.6 Organization of the Dissertation (Why disseration? Disseration is totally different from a Research Proposal
51.7. Limitations
6CHAPTER TWO
62.0 LITERATURE REVIEW
62.1 Overview
62.2 Conceptual Definitions
72.2.1 Work Place Stress
72.2.2 Employee Performance
82.3. Theoretical Literature Review
82.3.1 Employees Performance Management
82.3.2 Stress at Workplace
10Work Stress and Employees Performance
10Theories of Work Stress
10The Job Demands-Control Theory (JD-C)
11The Role Theory
11Empirical Literature Review
12Assessing Employee Performance
132.5.3 Relationship between work Stresses and Employee Performance
13Research Gap Identified
142.9 Statement of Hypotheses
15CHAPTER THREE
153.0 RESEARCH METHODOLOGY
153.1 Overview
153.2 Research Design
153.3 Study Population
153.4 Area of the Research
163.5.1 Sample Size
173.5.2 Sampling Procedure
183.6. Variables and Measurements
193.7 Methods and Instrument Used for Data Collection
193.8. Data Processing and Analysis
21CHAPTER FOUR
214.0 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
214.1 Summary
22References
CHAPTER ONE
1.0 INTRODUCTION (Omit the numbers. LOOK AT MY DISSERATION)
1.1 Background You do not need to put backgr.
Stress and Healthcare Workers Productivity at Lexington Medical blazelaj2
Stress and Healthcare Workers Productivity at Lexington Medical Center
Veronica N Cornell
Claflin University
ABSTRACT
[BY1]
The research proposal aim at assessing the effect of workplace stress on workers productivity at Lexington Medical Center. The objective of the research is to assess worker productivity, the stress level among health workers, and the extent to which their productivity and performance is related to stress levels. The research survey will be a cross section and it will involve 120 participants (about 20% of the total population) and it will be conducted through convenience sampling techniques and stratified sampling. The data will be collected using questionnaire and descriptive statistical regression analysis will be used for data analysis. Before the actual data collection, there will be pilot study to determine reliability of the
[BY2]
research process. At this stage, the research will include expert opinion to enhance validity of the research.
This abstract did not give a background and summary of your study, and your expected outcome
Keywords:
Employee productivity/ job performance, work place stress/occupational stress, doctors, nurses, medical attendant Lexington Medical Center.
Table of Contents
[BY3]
Why do you have a background and Statement of the Problem? The background can be covered in the statement and description of the problem.
CHAPTER ONE............................................................................................................ 1
1.0 INTRODUCTION.. 1
1.1 Background to the Research Problem.. 1
1.2 Statement of the Research Problem.. 3
1.3 Objectives of the Study. 3
1.3.1General Objective. 3
1.3.2 Specific Objectives. 4
1.4. Research Questions. 4
Why do you have a General and a Specific Objectives and Research Question. Please read the textbook or my powertpoint and understand it. Also my dissertation..
1.4.1 General Research Question. 4
1.4.2 Specific Research Questions. 4
1.5 Relevance of the Research. 4
1.6 Organization of the Dissertation (Why disseration? Disseration is totally different from a Research Proposal 5
1.7. Limitations. 5
CHAPTER TWO.. 6
2.0 LITERATURE REVIEW... 6
2.1 Overview.. 6
2.2 Conceptual Definitions. 6
2.2.1 Work Place Stress. 7
2.2.2 Employee Performance. 7
2.3. Theoretical Literature Review.. 8
2.3.1 Employees Performance Management 8
2.3.2 Stress at Workplace. 8
Work Stress and Employees Performance. 10
Theories of Work Stress. 10
The Job Demands-Control Theory (JD-C) 10
The Role Theory. 11
Empirical Literature Review.. 11
Assessing Employee Performance. 12
2.5.3 Relationship between work Stresses and Employee Performance. 13
Research Gap Identified. 13
2.9 Statement of Hypotheses. 14
CHAPTER THREE.. 15
3.0 RESEARCH METHODOLOGY.. 15
3.1 Overview.. 15
3.2 Research Design. 15
3.3 Study Population. 15
3.4 Area of the Research. 15
3.5.1 Sample Size. 16
3.5.2 Sampling Procedure. 17
3.6. Variables and Measurements ...
JONAVolume 47, Number 1, pp 41-49Copyright B 2017 Wolters .docxvrickens
JONA
Volume 47, Number 1, pp 41-49
Copyright B 2017 Wolters Kluwer Health, Inc. All rights reserved.
T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N
The Effect of Reported Sleep,
Perceived Fatigue, and Sleepiness on
Cognitive Performance in a Sample of
Emergency Nurses
Lisa A. Wolf, PhD, RN, CEN, FAEN
Cydne Perhats, MPH
Altair Delao, MPH
Zoran Martinovich, PhD
OBJECTIVE: The aim of this study is to explore
the relationship between reported sleep, perceived
fatigue and sleepiness, and cognitive performance.
BACKGROUND: Although evidence suggests that
fatigue and sleepiness affect the provision of care in
inpatient units, there is a lack of research on the sleep
patterns of emergency nurses and the effects of dis-
turbed sleep and fatigue on their cognitive abilities
and susceptibility to medical errors.
METHODS: A quantitative correlational design was
used in this study; in each of 7 different statistical models,
zero-order relationships between predictors and the
dependent variable were examined with appropriate
inferential tests.
RESULTS: Participants reported high levels of
sleepiness and chronic fatigue that impeded full
functioning both at work and at home.
CONCLUSIONS: Although high levels of self-reported
fatigue did not show any effects on cognitive function,
other factors in the environment may contribute to
delayed, missed, or inappropriate care. Further research
is indicated.
Studies of worker fatigue in the military and com-
mercial trucking industries1,2 suggest that long hours,
especially extending into overnight, can be hazardous
in terms of the potential for errors due to sleepiness
and reduced vigilance. Medical providers, both nurses
and physicians, are at risk because of the need for
around-the-clock coverage and the number and type
of decisions they must make in a given time span; in
1989, the Bell Commission Report cited sleep depri-
vation in medical house officers as a major contrib-
utor to the 1984 death of Libby Zion, an 18-year-old
who died at New York Hospital, leading to a restruc-
turing of the hours involved in medical residencies.3
The long (up to 36 hour) shifts of the medical resi-
dents in charge of her care and the consequences of
their fatigue on the decisions that were made were
cited as factors in her death. As a result of their inves-
tigation of the case, the Bell commission recommen-
ded limiting the work hours of medical residents to
less than 80 hours a week and no more than 24 hours
in a row, and subsequent research has led to similar
recommendations for the nursing workforce.4,5
Emergency care settings are chaotic environ-
ments, where there is high patient turnover, constantly
changing priorities and frequent changes in patient
condition. High demand work settings are associated
with increased fatigue, which can impair nurses_ at-
tentiveness and ability not only to recognize potential
errors they might commit but also to recognize and
mitigate the errors of others, inc ...
Physician Burnout & Mindfulness Training: An Approach That Works By Floyd ArthurFloyd Arthur
This document discusses physician burnout and how mindfulness training can help address it. It notes that over half of physicians experience burnout symptoms like emotional exhaustion and dissatisfaction with work-life balance. Common causes include too much bureaucracy, long work hours, and feeling like "just a cog in the wheel." Burnout has negative impacts like increased risk of mistakes, substance abuse, and leaving the profession. The document then discusses how mindfulness meditation through training can significantly reduce stress and burnout symptoms. It provides details on the positive effects of both intensive long-term mindfulness training programs and abbreviated shorter mindfulness courses for physicians.
This study examined the relationship between stress responses and lifestyle factors like sleep, eating, and overtime work among 3,017 Japanese workers. The results showed:
1) 8.4% of participants were in the stress group. Stress responses were associated with sleeping less than 6 hours among women, and working over 45 hours of overtime among men.
2) Eating at night was associated with stress responses in the initial univariate analysis for both men and women. However, this relationship did not remain significant in the multivariate analysis.
3) Overall, stress responses were related to lifestyle factors for women but not for men. Short sleep was linked to stress for women, while long work hours were linked to stress for men.
A Corporate Wellness Program And Nursing Home Employees HealthValerie Felton
This study evaluated the impact of a corporate wellness program across 18 nursing homes. The nursing homes were categorized based on the level of wellness programming offered: well-developed, emerging, or no program. Surveys were administered to employees to assess health behaviors, working conditions, and beliefs. There were no significant differences found between programming levels for most health outcomes. Workers in facilities with well-developed programs had a slightly lower average BMI and were less likely to exercise regularly or be non-smokers. The authors conclude the program had modest influence on employee health and that more supportive approaches are needed.
Evaluation of Research Essay Discussion.pdfsdfghj21
This document provides guidelines for an assignment to evaluate empirical research related to a PICOT question. Students are instructed to write a 1,250-1,500 word paper evaluating literature on their PICOT question by addressing study conclusions, merits, and limitations. Feedback from instructors is also discussed, noting a revised PICOT question focusing more specifically on patient outcomes and data collection time period.
Objective: The aim of the study was to identify level of stress among nurses according to their job status. Background: Stress is highly associated with nursing profession. This stress is caused by several factors both personal and organizational such as educational level, gender, nature of work environment and work overload etc. These factors directly or indirectly expose nurses to a considerable level of stress. If a nurse works at two places, their stress level will predictably be much higher than that of those who work at a single place. Methodology: Quantitative analytical cross-sectional study design was applied in a private tertiary care hospital at Peshawar, Pakistan. Study population included all nurses working in the mentioned hospital. Universal sampling technique was used for double jobber nurses, while convenient sampling technique was used for single jobber nurses. An adopted questionnaire was used for data collection. Chi-square test was applied to analyze the data. Result: Among double jobber nurses, 23.33% had severe, 63.34% had moderate, and 13.33% had mild level of stress. On the other hand, there was no severe level of stress among single jobbers; only 20% had moderate and 80% had mild level of stress. Conclusion: The current study identified that level of stress was higher in double jobber nurses as compared to single jobber nurses. The study would have been more generalizable if more tertiary care hospitals were included for data collection.
This document discusses the debate around nurses working 12-hour shifts versus 8-hour shifts. Research is being conducted to understand the impact of shift length on staff, patient safety, and job satisfaction. Some nurses prefer 12-hour shifts for more days off, while others argue it can affect quality of care. The goal is for employers to offer a choice between 8- and 12-hour shifts to increase job satisfaction and reduce fatigue, while balancing staffing needs. A survey was conducted to evaluate readiness for implementing a choice in shift lengths.
This summary provides an overview of a paper presented by Dr. Jonathan Passmore to the Danish Psychological Association in 2009 on the topic of mindfulness at work and in coaching:
1) The paper discusses how mindfulness can benefit both individuals and organizations by improving factors like stress, well-being, performance, and safety culture.
2) Research shows that mindfulness enhances psychological well-being, creativity, emotional intelligence, and learning. It also improves physiological measures like blood pressure.
3) The paper argues that introducing mindfulness practices can help create "truly healthy organizations" by fostering learning, communication, and a sense of community.
This document outlines a proposed study to compare stress levels among nurses working in psychiatric versus multispecialty hospitals in Bangalore, India. It notes that nurses experience various workplace stressors and are at high risk for stress and burnout. The study aims to identify the sources and extent of stress in these settings to inform strategies for supporting nurses' health and reducing absenteeism. It will utilize validated scales to assess stress levels and correlates among nurses to determine if they differ between hospital types. The results could help hospitals acknowledge and address chronic workplace stress impacting nurses.
This study examined aspects of sustainability among Swiss psychiatrists by assessing levels of cooperation, job satisfaction, and burnout. The researchers surveyed 352 psychiatrists. They found that cooperation was highest with general practitioners and lowest with community mental health providers. Overall job satisfaction was assessed as high, while burnout rates were below concerning thresholds. Both job satisfaction and burnout correlated inversely, with higher satisfaction associated with lower burnout. Cooperation was positively associated with job satisfaction and inversely with burnout. The study concludes that fostering sustainability in outpatient psychiatric care requires considering personal, organizational, and supportive factors that can influence cooperation, satisfaction, and burnout.
JOB SATISFATION AND NURSE PATIENT RATIO24Table of Contents.docxchristiandean12115
This document provides an overview of a research study that examines the relationship between nurse job satisfaction, nurse-patient ratios, and nurse fatigue. It includes an introduction that outlines the background, problem statement, purpose, significance and research questions. It also presents hypotheses and a brief literature review. The methodology chapter describes the research design, sample, instruments and data analysis plan. Results, discussion and conclusions chapters are also outlined. The document provides a framework to guide the proposed empirical study on the key factors relating to nurse fatigue.
Running head: LITERATURE REVIEW 13
LITERATURE REVIEW 8
Literature Review: ICU Quiet Time
Ese Noskhare
Walden University
Essentials of Evidence-Based Practice
NURS-6052-45
Running head: LITERATURE REVIEW 8
Introduction
Literature review represents very integral aspects of the research process. It is aimed at deriving out the current knowledge on the selected topic including the common patterns, contradictions, and gaps and, as a result, aid in determining what needs to be done by future researchers. In the present paper, the aim is to analyze and synthesize studies that have been conducted focusing on ICU Quiet time and more particularly, the effects of strict enforcement of scheduled hours of rest time on multiple incidences of delirium in adult critical-care patients in the ICU.
History
The onset of ICU Quiet time has been reported as dating back in the 1960s. It originated in the North America and, in particular, Quebec, Canada. It took place as a result of the natural continuation of creativity and innovations that occurred in Quebec. The period saw the introduction of the Hospital Insurance and Diagnostic Services Act, which brought rise to the concept and practice of public health insurance. This triggered the implementation of varied infrastructural projects in the health care. It is in the course of these changes that quiet time in ICUs was introduced with the aim of speeding up the healing of the patients. This practice prevails even in the modern day times.
Current Evidence
For a considerable period, research on ICU Quiet time has been rampant. Most of the frequent cited studies include Gardner, Collins, Osborne, Henderson, and Eastwood (2008), Maidl, Leske, and Garcia (2013), Olson, Borel, Laskowitz, Moore, and McConnell (2001), Richardson, Thompson, Coghill, Chambers, and Turnock (2009), Taylor (2008) and Weinhouse et al. (2009).
In their study, Gardner, Collins, Osborne, Henderson, and Eastwood (2008) used a sample of 299 participants. The sample received a scheduled quiet time intervention. In the process, the researchers evaluated the levels of noise, the rest of the inpatients, their sleep behaviors, and their well-being. It was concluded that the majority of the ICU patients are not usually concerned with noise. However, they often prefer a period in which they are not exposed to noise. The researchers also identified that nurses also see a great value in ICU Quiet time. In another study by Maidl, Leske, and Garcia (2013), the researchers carried out a set of non-randomized, uncontrolled quiet time trials in ICUs. The intervention involved a reduction of the environmental stressors and enhanced patient rest prior to the onset of the trials. It was determined that ICU patients often prefer quiet time. Also, according to the researchers, the nursing practitioners that work in the ICUs also value quiet time as they are allowed to chart and, as a result, reduce their levels of stress. In the process, better care is .
Respond to the Main post bellow, in one or more of the follomickietanger
Respond to the Main post bellow, in one or more of the following ways:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
INITIAL POST
An Intervention Program to Promote Health-Related Physical Fitness in Nurses
This quantitative, quasi-experimental study conducted by Yaun et al. (2009) aimed to determine the effects of an exercise intervention on nurses’ health-related physical fitness. The researchers also expressed an explicit interest in the relationship between physical fitness and the incidence of musculoskeletal disorders. Taiwanese nurses from five different units volunteered to be part of the study. The participants were divided into two groups with 45 nurses in the experimental group and 45 nurses in the control group. There was no randomization, but all the participants gave written informed consent (Yaun et al., 2009).
Internal Validity
According to Polit and Beck (2017), internal validity pertains to the empirical relationship between the independent variable and the final results. Researchers must establish that the intended cause created the effect, and that it was not influenced by other variables (Polit & Beck, 2017). After all, correlation does not equal causation, and an astute researcher will adeptly identify and control convoluting variables. Further, Andrade (2018) asserts that internal validity assesses whether the design of the study, the conduct of the researchers, and the analysis of the results answer the research question without bias (Andrade, 2018).
Consequently, the research conducted by Yaun et al. did have some issues that negatively impacted the internal validity of their research. Firstly, convoluting variables were not adequately controlled. The exclusion criteria consisted of cardiovascular disease, diabetes, hypertension, renal disease, pulmonary disease, severe musculoskeletal aches, and pregnancy. However, other significant variables such as age, gender, marital status, educational level, or other medical issues. It is worth noting that the diet and exercise habits of the participants were not limited by the researchers.
Moreover, the nurses in the experimental group worked a fixed schedule whereas nurses in the control group worked alternating shifts. Secondly, the lack of randomization coupled w ...
Similar to RESEARCH ARTICLE Open AccessExperiences of reduced work ho.docx (20)
According to the textbook, the Federal Disaster Assistance Act of 19.docxronak56
According to the textbook, the Federal Disaster Assistance Act of 1950 (P.L. 81-875) defined the roles and responsibilities during natural disasters. Once the president issued a disaster declaration, federal relief resources could flow to the affected areas for response and recovery. The president would then delegate administrative control of relief efforts to the Housing and Home Finance Administration. This law also instituted the federal role in natural disasters as a supportive role, while instituting primary responsibility for disaster response and recovery with local and state governments. How had this changed by 1978? Why did it change? Do you agree with the change? Why, or why not?
300 WORDS
APA FORMAT
.
According to the Council on Social Work Education, Competency 5 Eng.docxronak56
According to the Council on Social Work Education, Competency 5: Engage in Policy Practice:
Social workers understand that human rights and social justice, as well as social welfare and services, are mediated by policy and its implementation at the federal, state, and local levels. Social workers understand the history and current structures of social policies and services, the role of policy in service delivery, and the role of practice in policy development. Social workers understand their role in policy development and implementation within their practice settings at the micro, mezzo, and macro levels and they actively engage in policy practice to effect change within those settings. Social workers recognize and understand the historical, social, cultural, economic, organizational, environmental, and global influences that affect social policy. They are also knowledgeable about policy formulation, analysis, implementation, and evaluation. Social workers:
Identify social policy at the local, state, and federal level that impacts well-being, service delivery, and access to social services;
Assess how social welfare and economic policies impact the delivery of and access to social services;
Apply critical thinking to analyze, formulate, and advocate for policies that advance human rights and social, economic, and environmental justice.
This assignment is intended to help students demonstrate the behavioral components of this competency in their field education.
To prepare: Working with your field instructor, identify, evaluate, and discuss policies established by the local, state, and federal government (within the last five years) that affect the day to day operations of the field placement agency.
The Assignment (1-2 pages):
Describe the policies and their impact on the field agency.
Propose specific recommendations regarding how you, as a social work intern, and the agency can advocate for policies pertaining to advancing social justice for the agency and the clients it serves.
.
According to the text, economic outcomes measured by economic gr.docxronak56
According to the text, economic outcomes measured by economic growth is affected by a number of factors. Also, hundreds of empirical studies on economic growth across countries have highlighted the correlation between economic growth and a variety of variables.
Claims regarding the determinants of economic growth are conditional, and the findings depend on the variables used. However, the availability of physical capital or infrastructure, government consumption, terms of trade, macroeconomic stability, the rule of law, regulatory quality, government effectiveness, foreign direct investments, population size, and natural resource availability are the most consistent findings of empirical studies on economic growth.
Review the literature on economic growth and provide a summary of how:
Population affects economic growth
Natural Resource Abundance affects economic growth
Note: The answers you provide to each of these sub-questions should not be more than 15 sentences.
Also note that because this is a literature review you must cite credible sources; avoid using news articles.
The examples below should serve as a guide
Example 1: The example below shows how inflation affects investment in a study of the effect of inflation on investment.
The destabilizing effect of inflation on investment has been a major source of debate in economic and business literature. Generally, inflation is often considered a sign of macroeconomic instability and the inability of government to control macroeconomic policy, both of which contribute to an adverse investment climate (Fischer, 2013; Greene & Villanueva, 1991). However, the empirical evidence is still far from convincing. While some authors claim positive effects of inflation on investment, others hold that inflation poses a “stealth” threat to investments. For example, Greene and Villanueva (1991) argue that high rate of inflation adversely affects private investment activity by increasing the riskiness of long-term investment projects. Also, Fischer (2013) observed that inflation uncertainty is associated with substantial reduction in total investment. On the contrary, McClain and Nicholes (1993) found that investment and inflation are positively related to each other.
Example 2: The example below shows how natural resource endowments affects income inequality in a study of the determinants of income inequality.
The nexus between natural resource endowments and income inequality has also been widely debated and has inspired a long history of research in both economics and political science (see, for example, Fum and Hodler, 2010; Goderis and Malone, 2011; Leamer, Maul, Rodriguez, and Schott, 1999; Carmignani, 2013; Parcero and Papyrakis, 2016; Bourguignon and Morrisson, 1998). For example, Anderson et al., (2004) argue that natural resources endowment provide a plausible explanation as to why the observed levels of inequality are significantly higher in both sub-Saharan Africa and Latin America.
According to the Council on Social Work Education, Competency 5.docxronak56
According to the Council on Social Work Education, Competency 5: Engage in Policy Practice:
Social workers understand that human rights and social justice, as well as social welfare and services, are mediated by policy and its implementation at the federal, state, and local levels. Social workers understand the history and current structures of social policies and services, the role of policy in service delivery, and the role of practice in policy development. Social workers understand their role in policy development and implementation within their practice settings at the micro, mezzo, and macro levels and they actively engage in policy practice to effect change within those settings. Social workers recognize and understand the historical, social, cultural, economic, organizational, environmental, and global influences that affect social policy. They are also knowledgeable about policy formulation, analysis, implementation, and evaluation. Social workers:
Identify social policy at the local, state, and federal level that impacts well-being, service delivery, and access to social services;
Assess how social welfare and economic policies impact the delivery of and access to social services;
Apply critical thinking to analyze, formulate, and advocate for policies that advance human rights and social, economic, and environmental justice.
This assignment is intended to help students demonstrate the behavioral components of this competency in their field education.
To prepare: Working with your field instructor, identify, evaluate, and discuss policies established by the local, state, and federal government (within the last five years) that affect the day to day operations of the field placement agency (
Georgia Department of Family and Children Services
).
The Assignment (1-2 pages):
Describe the policies and their impact on the field agency.
Propose specific recommendations regarding how you, as a social work intern, and the agency can advocate for policies pertaining to advancing social justice for the agency and the clients it serves.
.
According to the Council for Exceptional Children (CEC), part of.docxronak56
According to the Council for Exceptional Children (CEC), part of being a well-prepared special educator includes “developing relationships with families based on mutual respect and actively involving families and individuals with exceptionalities in educational decision making” (Council for Exceptional Children, 2015, Special Education Professional Ethical Principles, E). This includes advocating for parental involvement by providing information on educational rights and safeguards in a way that creates accessibility and transparent IEP meeting procedures (Council for Exceptional Children, 2015).
Hammond, Ingalls and Trussell (2008) investigated the experiences of those family members who attended an initial IEP meeting and then subsequent meetings over the next four years. Their findings indicated that the overwhelming majority of the 212 family participants agreed that the child needed special education services but had negative emotional responses to the initial team meeting. Some of the most beneficial information collected included acknowledging the emotions tied to having a child initial diagnosed with a disability; stronger communication skills by education professionals during the team meeting; and additional measures to better prepare parents for the team meetings (Hammond, Ingalls, & Trussell, 2008). Similarly, the article,
Building Parent Trust in the Special Education Setting (Links to an external site.)
(Wellner, 2012) was written to emphasize the importance of trust building strategies to avoid costly due process hearings and to maximize relationships with all involved in making decisions on behalf of the student with special needs.
Initial Post:
After reading the article, After reading the article,
The 5-Point Plan
, reviewing the Council for Exceptional Children’s (CEC) , reviewing the Council for Exceptional Children’s (CEC)
Special Education and Professional Ethical Principles and Practice Standards (Links to an external site.)
, and reading
Building Parent Trust in the Special Education Setting (Links to an external site.)
you will create an initial response depending on the first letter of your last name.
If your last name begins with the letters A – M:
You will respond as one of the parent participants in this the Hammond, Ingalls and Trussell study. Begin by explaining how you felt attending your child’s first IEP meeting, using the article and the Instructor Guidance as a foundation for your narrative. Then, describe how future IEP meeting experiences changed (improved or declined) and why. Finally, using the
CEC Professional Practice Standards for Parents and Families (Links to an external site.)
and
Building Parent Trust in the Special Education Setting (Links to an external site.)
, provide at least three suggestions to the special education team leader for how to improve this experience for parents of newly diagnosed children with disabilities.
.
According to the article, Answer these two questions. Why did Ma.docxronak56
According to the article, Answer these two questions.
Why did Marx believe that capitalism would fall on its own? Why did his predictions not come true? (hint: how has the economy changed since Marx’s time?
Describe Robert Owen’s “New Lanark” community? What were his innovations? Did he suspend either private property or market economics? Are there people today who follow a similar business model?
.
According to Neuman’s theory, a human being is a total person as a c.docxronak56
According to Neuman’s theory, a human being is a total person as a client system and the person is a layered, multidimensional being. Each layer consists of a five-person variable or subsystem: (1) physiological, (2) psychological, (3) sociocultural, (4) developmental, and (5) spiritual.
Considering the 'spiritual' variable- Do you feel this variable exists at all? Does it have as wide-ranging results as Neuman claims? Is it appropriate for an APRN to participate in or work with the patient’s spiritual dimension?
.
According to Rolando et al. (2012), alcohol socialization is the pr.docxronak56
According to Rolando et al. (2012), “alcohol socialization is the process by which a person approaches and familiarizes with alcohol learns about the values connected to its use and about how, when and where s/he can or cannot drink.”
Based on the focus group findings, describe what the first drink means in both Italy and Finland, and what types of attitudes are connected with different types of socialization processes.
.
According to your readings, cloud computing represents one of th.docxronak56
According to your readings, cloud computing represents one of the most significant paradigms shifts in information technology (IT) history, due to an extension of sharing an application-hosting provider that has been around for many years, and was common in highly regulated vertical industries like banks and health care institutions. The author’s knowledge from their research continue to assert that, the impetus behind cloud computing lies on the idea that it provides economies of scale by spreading costs across many client organizations and pooling computing resources while matching client computing needs to consumption in a flexible, real-time version.
Identify the issues and risks that pose concern to organizations storing data in the cloud - briefly support your discussion.
.
According to this idea that gender is socially constructed, answer.docxronak56
According to this idea that gender is socially constructed, answer the following questions:
1. What does it mean to be a man in the U.S.? What does it mean to be a woman?
2. From what institutions do we learn these gender roles?
3. How do these clips demonstrate the ways in which gender is socially constructed in the U.S.? Do the concepts discussed in the clips resonate with you? Why or why not?
In Persepolis, the main character Marji struggles to define her identity as an Iranian woman in a changing society.
· What roles are depicted for women in Iranian society in the film? How do they change over time?
· How does Persepolis demonstrate the ways in which gender and identity are influenced in many ways, by different processes across cultures? How are gender roles in Iran similar, or different to gender in the U.S.?
· What are some of the stereotypes that exist about Muslim women and how does Abu-Lughod in “Do Muslim Women Need Saving” and Persepolis complicate these stereotypes?
Answer the following questions 2 full pages
Running head: MAJOR HEALTH CARE PROBLEMS IN THE U.S. 1
Major Health Care Problems in the U.S.
Jane Doe
ID: 1212121
MAJOR HEALTH CARE PROBLEMS IN THE U.S. 2
Major Health Care Problems in the US
Problem statement: High and continuously rising cost of health care has been and still is one of
the biggest challenges affecting the Health Care system in United States.
Methods of Examining the Problem
Both qualitative and quantitative research methods should be used to fully understand the
issue of high cost of care in the US. Quantitative methods like surveys and experimentations will
aid in estimating the prevalence, magnitude and frequency of the problem in different regions.
On the other hand, qualitative methods like case studies and observation will help describe the
extent and complexity of the issue. The two approaches need to work in complementation to
obtain a clear understanding of this menace.
Surveys, as a quantitative research method, is one of the most effective in the social
research and present a more viable method of examining the cost of health in the country. They
involve asking of questions in the form of questionnaires and interviews. Questionnaires are
written questions to which the response can be open ended or multiple-choice format. This
would be used to gain information about cost within determinants that are of
disagree/neutral/agree nature. An example is if patients are contented with the cost of services
they get or they deem the cost of cover worthy. Interviews, the researcher discussing issues with
the respondents, are to be used to gain more details on already known aspects of the system. This
may include gathering information to inform policies, administration and use of technology to
minimize the cost of care.
Since health cost in the US is not a new challenge and there have been studies about it,
qualitative methods like .
According to Thiel (2015, p. 40), CSR literature lacks consensus fo.docxronak56
According to Thiel (2015, p. 40), “CSR literature lacks consensus for a standard definition. Typically, many people who are familiar with the concept will initially define CSR within the three domains of the social, economic and natural environments.”
Come up with your own definition of what you believe is a good definition of CSR that you would like your company to follow.
Afterward, explain each part of your definition and why you believe it is best.
.
According to recent surveys, China, India, and the Philippines are t.docxronak56
According to recent surveys, China, India, and the Philippines are the three most popular countries for IT outsourcing. Write a short paper (2-4 paragraphs) explaining what the appeal would be for US companies to outsource IT functions to these countries. You may discuss cost, labor pool, language, or possibly government support as your reasons. There are many other reasons you may choose to highlight in your paper.
.
According to Rolando et al. (2012), alcohol socialization is th.docxronak56
According to Rolando et al. (2012), “alcohol socialization is the process by which a person approaches and familiarizes with alcohol learns about the values connected to its use and about how, when and where s/he can or cannot drink.”
Based on the focus group findings, describe what the first drink means in both Italy and Finland, and what types of attitudes are connected with different types of socialization processes. Respond to two posts identifying how positive values can be connected to first memories of drinking.
.
According to the author, Social Security is an essential program, .docxronak56
According to the author, Social Security is an essential program, but its future is looking unpromising unless we start by eliminating the payroll tax cap.
In the author’s proposal to keep the funding open, the author proposes the acceptance of Bernie Sanders’ “Keeping Our Social Security Promises Act,” which the author suggests would removes the payroll tax cap. To elaborate further, the author stated that the reason for the cap on the social security is because of the uneven amount of participation during elections which makes the rich influential in governance. The author stated that, research have found that the rich who made over $125,000 contributed 35% in campaigns. According to the author, this act causes a major problem regarding the shaping of the social security because people with lower income would not be able to contribute that amount of money towards campaigns. The author also states that it causes greater income equality, since those who contribute are rich and as a matter of fact get more benefits from political power in the form of payroll tax cap. This in the authors words, compromises the state of social welfare in the United States because those active in politics don’t have the same views as the poor who are focused on housing, poverty, and health. Congressional Research Service was used to predicts that, if tax cap is not removed, there will be a permanent increase of tax rate from 12.4% to 15.1% which would hurt people making less than the current tax cap currently at $132,900 or, cutting benefits by 20% in 2035 and continuously rising every year.
In as much as the author makes a good point on the percentage of rich people that donated to campaign, the author failed to state how much the rich get in payroll tax cap since that is a major part of the authors argument. The authors failed to indicate how an increase in tax rate would affect people making less than the current tax cap which is $132,900. To sum it up, the author failed to expand and give more numeric evidence to support the argument.
In addition, to provide a guideline in eliminating payroll tax cap, the author suggested a bill introduced by Bernie Sanders called, Keeping Our Social Security Promises Act. The bill according to the author seeks to remove the cap placed on payroll taxes. The author further stated the bill will help Solvency to expand for 75 years without increasing taxes for those who earn less than $250,000, the only people who will see a change are those earn more than $250,000. According to the Congressional Research Service as stated by the author, removing the cap would eliminate 84% of the projected shortfall. The author stated that, the top 200 CEOs would have to contributed $341,291,106 towards Social Security when the tax cap is removed. In addition, the author stated that, removing the cap would eliminate 84% of the projected shortfall. The author proposes an increase in the taxable payroll from 12.40% to 12.83% to keep it solvent.
According to Morrish, the blame for the ever-growing problem of disc.docxronak56
According to Morrish, the blame for the ever-growing problem of discipline in schools rests at least in part on popular discipline theories, which he believes have gone to excess in allowing students to make choices concerning how they will conduct themselves in school. What are your thoughts about Morrish’s ideas?
.
According to DuBrin (2015), Cultural intelligence is an outsiders .docxronak56
According to DuBrin (2015), "Cultural intelligence is an outsider's ability to interpret someone's unfamiliar and ambiguous behavior the same way that person's compatriots would" (p. 177). In this case, how would you incorporate cultural intelligence within a team setting? Please explain.
Your journal entry must be at least 200 words
.
According to Edgar Schein, organizational culture are the shared.docxronak56
According to Edgar Schein, organizational culture are the shared beliefs and values among a group of people which influences how they perceive, think, and react in the organization. There are four types of organizational culture:
Clan-Internal focus that values flexibility
Adhocracy-A risk taking culture with an external focus on flexibility
Market-A competitive culture with an external focus on profits over employee satisfaction
Hierarchy-A structured culture valuing stability and effectiveness internally
How would you describe the organizational culture of a pr
evious or current place of employment? And why?
Do you think this type of culture is best suited to help the company achieve its strategic goals? Explain.
.
According to DuBrin (2015), the following strategies or tactics are .docxronak56
According to DuBrin (2015), the following strategies or tactics are identified for enhancing your career:
develop career goals,
capitalize on your strengths and build your personal brand,
be passionate about and proud of your work,
develop a code of professional ethics and prosocial motivation,
develop a proactive personality,
keep growing through continuous learning and self-development,
document your accomplishments,
project a professional image, and
perceive yourself as a provider of services. (p. 430)
Identify and explain three career-enhancing techniques or tactics in advancing your career.
Your essay should be at least two pages and should include an introduction, a body of supported material (paragraphs), and a conclusion. Be sure to include two references (on a reference page), and follow all other APA formatting requirements. The reference page does not count toward the total page requirement.
Be sure to apply the proper APA format for the content and references provided.
.
According to DuBrin (2015), the following strategies or tactics .docxronak56
According to DuBrin (2015), the following strategies or tactics are identified for enhancing your career:
develop career goals,
capitalize on your strengths and build your personal brand,
be passionate about and proud of your work,
develop a code of professional ethics and prosocial motivation,
develop a proactive personality,
keep growing through continuous learning and self-development,
document your accomplishments,
project a professional image, and
perceive yourself as a provider of services. (p. 430)
Identify and explain three career-enhancing techniques or tactics in advancing your career.
Your essay should be at least two pages and should include an introduction, a body of supported material (paragraphs), and a conclusion. Be sure to include two references (on a reference page), and follow all other APA formatting requirements.
.
Access the Mental Measurements Yearbook, located in the Univer.docxronak56
Access
the Mental Measurements Yearbook, located in the University Library.
Select
two assessments of intelligence and two achievement tests.
Prepare
a 13 slide presentation about your selected instruments. In your analysis, address the following:
Critique the major definitions of intelligence. Determine which theory of intelligence best fits your selected instruments. Explain how the definition and the measures are related.
Evaluate the measures of intelligence you selected for reliability, validity, normative procedures, and bias.
Your selected intelligence and achievement assessments. How are the goals of the tests similar and different? How are the tests used? What are the purposes of giving these differing tests?
.
How to Setup Default Value for a Field in Odoo 17Celine George
In Odoo, we can set a default value for a field during the creation of a record for a model. We have many methods in odoo for setting a default value to the field.
Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...indexPub
The recent surge in pro-Palestine student activism has prompted significant responses from universities, ranging from negotiations and divestment commitments to increased transparency about investments in companies supporting the war on Gaza. This activism has led to the cessation of student encampments but also highlighted the substantial sacrifices made by students, including academic disruptions and personal risks. The primary drivers of these protests are poor university administration, lack of transparency, and inadequate communication between officials and students. This study examines the profound emotional, psychological, and professional impacts on students engaged in pro-Palestine protests, focusing on Generation Z's (Gen-Z) activism dynamics. This paper explores the significant sacrifices made by these students and even the professors supporting the pro-Palestine movement, with a focus on recent global movements. Through an in-depth analysis of printed and electronic media, the study examines the impacts of these sacrifices on the academic and personal lives of those involved. The paper highlights examples from various universities, demonstrating student activism's long-term and short-term effects, including disciplinary actions, social backlash, and career implications. The researchers also explore the broader implications of student sacrifices. The findings reveal that these sacrifices are driven by a profound commitment to justice and human rights, and are influenced by the increasing availability of information, peer interactions, and personal convictions. The study also discusses the broader implications of this activism, comparing it to historical precedents and assessing its potential to influence policy and public opinion. The emotional and psychological toll on student activists is significant, but their sense of purpose and community support mitigates some of these challenges. However, the researchers call for acknowledging the broader Impact of these sacrifices on the future global movement of FreePalestine.
THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...
RESEARCH ARTICLE Open AccessExperiences of reduced work ho.docx
1. RESEARCH ARTICLE Open Access
Experiences of reduced work hours for
nurses and assistant nurses at a surgical
department: a qualitative study
Kristina Gyllensten1* , Gunnar Andersson2 and Helena Muller2
Abstract
Background: There is a shortage of registered nurses in the
European Union (EU), and job dissatisfaction and perceived
high work–family conflict have been identified as causes of
nursing staff turnover. Reducing work hours is an organisational
intervention that could have a positive effect on nurses’ and
assistant nurses’ job satisfaction, work–life balance, and
willingness to stay in the job. An orthopaedic surgery
department at a large hospital in Sweden introduced reduced
work hours for nurses and assistant nurses in order to improve
the working situation. The aim of the study was to investigate
the experiences of reduced work hours and no lunch breaks
among nurses and assistant nurses at an orthopaedic surgery
department at a hospital in Sweden, with a particular focus on
recovery and psychosocial working environment.
Methods: A qualitative design was used in the study. Eleven
nurses and assistant nurses working at the particular
orthopaedic
department took part in the study, and semi-structured
interviews were used to collect data. The interviews were
analysed by
interpretative phenomenological analysis.
2. Results: Four main themes were developed in the analysis of the
data: A more sustainable working situation, Improved
work–life balance, Consequences of being part of a project, and
Improved quality of care. Each theme consisted of
subthemes.
Conclusions: Overall, reduced work hours appeared to have
many, mainly positive, effects for the participants in both
work and home life.
Keywords: Reduced work hours, Nurses, Assistant nurses,
Qualitative research, Psychosocial working environment,
Work-life balance
Background
There is a shortage of registered nurses in EU countries,
and this shortage is expected to worsen. Job dissatisfaction
and ill health are two important factors responsible for the
loss of practising nurses [1]. Perceived high work–family
conflict has also been identified as a cause of nursing staff
turnover, and not surprisingly, long working hours and
shift work have been found to be related to work–family
conflict among nurses [2, 3]. A large-scale study on work
shifts for European nurses found that long work hours
had a negative impact on fatigue, health and patient safety
[4]. Introduction of reduced work hours is an organisa-
tional intervention that could have a positive effect on
nurses’ and assistant nurses’ job satisfaction, work–life bal-
ance, and willingness to stay in the job.
The six-hour working day and reduced work hours are
hot topics that have received increasing attention in the
Swedish debate, with supporting arguments focusing on
decreasing unemployment and benefits for dual-earner
families and non-supporting arguments focusing on
4. mailto:[email protected]
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negative emotions, sleepiness, and fatigue and exhaus-
tion (on both workdays and weekends). Moreover, work
demands, instrumental managerial support, and work
intrusion on private life were also affected positively.
Bildt, Åkerstedt and Falkenberg [7] reported the findings
from a large-scale study where approximately 400 em-
ployees within the public sector in Sweden had reduced
work hours (30 h a week). The control group, with
approximately 400 individuals, worked 38–39 h a week.
Results showed that having reduced work hours was
greatly appreciated by the participants, who experienced
improved subjective health and quality of sleep and
reduced stress and tiredness. However, the study did not
find any changes in sick leave or in the biological health
markers. A smaller Swedish study investigated a nine-
hour reduction of the working week (to a six-hour day)
with a comparison group that continued working normal
working hours. The participants were mainly female
health care and day care nursery personnel. It was found
that the group with shortened work hours had improved
scores on social factors (time for family, friends, and so-
cial activities), sleep quality, mental fatigue, heart/re-
spiratory complaints, and attitude to work hours,
whereas the control group did not show changes during
the period of the study [8]. A more recent study investi-
gated shortened work hours and exercise during work
hours and the effect on productivity for dental staff in
Sweden [9]. One group received 2.5 h’ work reduction a
week, and the other group received 2.5 h’ work reduc-
tion with mandatory physical exercise during the re-
duced time. Both groups were compared to a control
5. group that did not receive any reduction in work hours
or physical exercise. It was found that all three groups
increased their productivity, with the largest increase in
the group with shortened work hours. Moreover, the
group with mandatory physical activity reported the
highest self-rated activity. Gothenburg municipality is
currently testing a six-hour workday for the staff at a
nursing home for the elderly. Another nursing home is
included as a comparison group. In the first interim
report the preliminary results from the first six months
are presented. It was found that the assistant nurses re-
ported more energy and less stress and were more active
than before. In addition, the assistant nurses experienced
that they were providing better care. A negative aspect
was that working many late shifts had a negative effect
on sleep [10]. A report that summarised the research on
reduced work hours concluded that there is no clear evi-
dence that reduced work hours have any effect on
objective health. Subjective health and job satisfaction
do, however, appear to be improved [11].
Reducing work hours concurrently with removing
breaks could mean a more intense work situation. A well-
conducted field study investigated the psychophysiological
effects of intensifying work by increasing workload and
reducing breaks for driving instructors [12]. The number
of examinations during a workday increased from 9 to 11.
Having 11 examinations during the day meant a more in-
tense workday and no breaks between the examinations.
The physiological activation was measured by adrenaline,
and it was found that under the regime of 11 exams a day
rates were high after work and stayed so until sleeping
time. This was significantly different compared to the situ-
ation of 9 exams a day. A conclusion from the study was
that the effects of intense work remain after the end of the
6. working day.
A lack of recovery from work plays an important role
in stress-related ill health [13]. Recovery can be defined
as the time needed to return to normal following the ter-
mination of a stressor. Several factors can influence the
need for recovery, such as coping factors, health status,
private situation, working conditions, and period of time
available to recover from work. If there is not enough
recovery between work shifts, there may be an accumu-
lation of work-induced fatigue, which increases the risk
of ill health [14]. Aronsson, Astvik, and Gustafsson [15]
examined the relationship between working conditions,
stress, lack of recovery, and health among personnel in
the welfare sector. It was found that the individuals in
the group ‘not recovered from work’ reported a number
of risk factors at work relating to difficult working
conditions and reported significantly worse ill health
compared to the recovered group. In a literature review
on recovery it was found that daily recovery appeared to
have a larger effect on health compared to the effects of
vacation, where the effects soon disappear. Sleep was
suggested to be the most important form of recovery,
although it was concluded that more research was
needed [16].
Despite the media interest in the topic, there appears
to be a lack of research investigating the effects of redu-
cing work hours and eliminating lunch breaks. Indeed,
we failed to find any qualitative studies investigating the
experiences of having shortened work hours and no
lunch breaks for nurses or assistant nurses. Therefore, the
aim of this study was to investigate the experiences of
reduced work hours and no lunch breaks among a group
of nurses and assistant nurses, with a particular focus on
recovery and psychosocial working environment.
7. Method
Background
The study took place at an orthopaedic surgery depart-
ment at a large hospital in Sweden. For a number of
years, the department had experienced problems with
high turnover and difficulty recruiting nurses and assist-
ant nurses. The staff suggested reducing work hours as a
solution to these problems, and the measure was first
Gyllensten et al. BMC Nursing (2017) 16:16 Page 2 of 12
introduced for a small group in November 2014 and for
all staff in February 2015. All nurses (orthopaedic and
anaesthetic) and assistant nurses reduced their work
hours from eight hours a day to six hours a day, except
for one day a week when they still worked eight hours,
where the two extra hours were intended for administra-
tive work tasks. Salaries were maintained at the same
level as for full-time work. The work schedule was chan-
ged from two shifts – a morning shift (7:00–16:00) and
afternoon/evening shift (12:30–21:30) – to three shifts –
morning (7:00–13:00), afternoon (12:30–18:30), and
evening shift (15:30–21:30). In addition, the lunch break
was eliminated, which meant that time-consuming
respite periods during ongoing operations could be
avoided. Extra staff were recruited, and more operating
theatres opened, and these could be opened during a
longer period of the day compared to previously. As a
consequence, more operations were performed, and the
idea was that these actions would balance the increased
cost of personnel.
Participants
8. All assistant nurses and nurses (117) at the particular
orthopaedic surgery department were invited via a letter
to participate in the study via a letter from the re-
searchers. If the answer was affirmative, the individual
was invited to participate in an interview about their ex-
perience of reduced working hours. Twelve presumptive
participants agreed to take part in the study, which
meant a response rate of 10%, and eleven subsequently
participated in the interviews. Ten participants were
women and one was male, three were working as assist-
ant nurses, and eight were working as registered nurses
(specialising in orthopedics or anaesthesia). The ages
ranged between 28 and 61 years, and the mean age was
45 years.
Procedure
Semi-structured interviews were used to collect the data,
and the interviews took place at the workplace during
working hours in November and December 2015. Two
of the authors conducted the interviews (HM and GA),
which took between 25 and 55 min. The interview
schedule was used as a guide and contained open ques-
tions on psychosocial work characteristics, recovery
from work, work–family conflict, health, economics, and
laws and regulations. The questions in the interview
schedule were based on previous literature on psycho-
social working conditions and work related health issues
for nurses and assistant nurses. The interviews were tape
recorded and transcribed verbatim. To keep the inter-
views anonymous, each participant was assigned a letter
as means of identification. The lines of the transcript
were numbered, so that each quote presented in this
article is referenced with a letter (participant) and a line
number from the transcript.
9. Data analysis
The interviews were transcribed verbatim and analysed
using interpretative phenomenological analysis (IPA) in
accordance with the guidelines presented by Smith, Jara-
man and Osborn [17]. IPA aims to explore in detail how
participants make sense of the world. It is a phenomeno-
logical approach that aims to capture the participants’
experiences of the phenomenon that is being studied.
Therefore, it was suitable for the current study, because
the aim was to explore the participants’ experiences of
shortened working hours. The approach is interpretative,
as the researcher is trying to understand the experience
of the participant through a process of interpretative
activity.
In a first step the interview data were coded using pen
and paper, line by line in the left margin of the tran-
script. From this first set of codes more abstract patterns
or preliminary themes were condensed for each inter-
view. Then a list of themes from all interviews was cre-
ated, and themes were grouped together, revised, or
deleted. At this stage it was important to check that the
analysis was in accordance with the data. After this
process a final list of themes and subthemes was devel-
oped (see Table 1).
Results
The aim of the study was to investigate the experiences
of shortened work hours and no lunch breaks in a group
of nurses and assistant nurses, with a particular focus on
recovery and psychosocial working environment. In the
analysis of the data four main themes were developed: A
more sustainable working situation, Improved work–life
balance, Consequences of being part of a project, and
Improved quality of care. Each theme had a number of
subthemes (see Table 1).
10. A more sustainable working situation
All the participants experienced that the reduced work
hours contributed to create a more sustainable working
situation. Several participants were now able to work
full-time, as they had sufficient energy to cope with this.
They also expressed that they were better able to recover
from work and that the work climate had improved.
However, there were some negative effects of having no
lunch breaks.
Energy for work
The reduced work hours gave the staff the opportunity
to work full-time while retaining their salary and pen-
sion benefits, which was experienced as very positive.
Several of the participants talked about how they were
Gyllensten et al. BMC Nursing (2017) 16:16 Page 3 of 12
able to work full-time, something which had not
previously been possible because of difficulty coping
with the physical work demands.
So it [the work] is tiresome and it was… well… yes,
one of the reasons why they introduced this, because
there were many that couldn’t cope with working
full-time. And then you pay for it yourself, both
with salary and future pensions. So it is a big trap
for women in health care. (registered nurse,
E: 110–115)
One participant explained how they had previously
had to work part-time, because the work was too
physically demanding for full-time hours.
11. Yes, I almost feel better now. My husband can
sometimes say, ‘I think you go to work every day’. Yes,
now I do, do that. Now I am not off one day a week,
I do actually go to work every day. But I can cope with
it, I don’t feel, ‘No I can’t cope’… So after almost a year
I still feel that I can cope. So hopefully I can work like
this until I am 65 years old, because my body can cope
with it. (registered nurse, D: 638–650)
Another aspect of coping with work was experiencing
that one’s energy lasted the whole working day. Several
participants experienced that, compared to previously,
they now had the energy to work in a different way
during the whole shift, which meant that they felt that
they were doing a better job.
I think that we deal with the things that need to be
done in a better way. I think so… All the materials
that arrive from the sterile section should be put away
in the shelves. We deal with that in a better way
than… We didn’t really have the energy before,
perhaps you had forty-five minutes left on your shift
and, ‘No, I don’t have the energy to do it, because I am
totally exhausted!’ But now I do it… because I have
the energy to do it. (registered nurse, D:208–212)
One participant described feeling that it was impos-
sible to be focused during the full six hours, but that it
still worked better than previously.
You don’t have the energy to keep focus for so long,
six hours in one go. Regardless… when I worked
eight hours then I had a dip around two, three in
the afternoon if I finished at four, then there was a
12. dip when I started looking at my watch. And that
dip comes now as well, although it comes at twelve
and I finish at one o’clock. (registered nurse,
C: 419–423)
Other participants experienced that it was easier to
keep going the last hours, since they knew that the shift
would end soon.
The ordinary evening shifts are half past twelve until
half past six, and if I work one of those tough shifts, if I
stand in one operation for the whole shift, and start at
seven the next day, of course, I will not feel well rested
in the morning. But just the thought of knowing that
when it is one o’clock I have SO much time to recover,
so it is cool. It becomes such a mental thing – you
manage to do it because it is such a short shift, even if
you are not well rested, because it is such a short
period of time until you get to rest. (assistant nurse,
J:249–259)
Improved recovery
Many expressed that they felt more recovered from work
compared to previously. This was a consequence of both
shorter workdays and a different work schedule that
allowed for more time between shifts. Before the re-
duced work hours were introduced, it was common to
work a morning shift after an evening shift. Several par-
ticipants described that they now, because of more avail-
able afternoon shifts, could work an afternoon shift after
having worked the evening shift. This change was seen
as a big improvement, because it was now possible to
have sufficient time for recovery between shifts, even
when working evening shifts.
It feels like there is more time for recovery, absolutely.
13. (assistant nurse, F: 257)
Like it always has been, all these years, by some
tradition in health care, that the one that has worked
the evening shift shall start early the next day in order
to have some kind of continuity. And it does not have
to be this way. We have the right to get a reasonable
Table 1 Main themes and subthemes
Main themes Subtheme
A more sustainable working situation Energy for work
Improved recovery
Improved work climate
Effects of having no lunch breaks
Improved work–life balance Energy for life outside work
Living life, not just surviving
Consequences of being part of a project Uncertainty over the
future Privilege
Personnel and recruitment
Improved quality of care Improved work performance
Effective use of available resources
Gyllensten et al. BMC Nursing (2017) 16:16 Page 4 of 12
14. rest between the shifts… Then, if you need to work at
7:00 once in a while because of some personal reason,
no one will forbid you, but the possibility is there, to
arrange for a long rest between the shifts. (registered
nurse, E: 156–166)
One person who used to work part-time, described
how she worked more days a week compared to previ-
ously, but because the days were shorter the daily recov-
ery was better, and there was less need for long
weekends to rest.
If you compare the schedule, now I work here almost
every day. If I compare, I used to belong to those who
preferred to work many days and then have more time
off. Like Friday to Sunday or Saturday to Monday. But
for my part I feel better doing this, working shorter
days, because when I worked many days I was very
tired once I had the days off. (registered nurse, G:
169–179)
Similarly, another participant explained that working
five day shifts in a row previously would have made her
exhausted, but that it would not feel as exhausting today
because of the shorter shifts.
If I see one, a week in front of me, where I am working
from 7:00–16:00 five days in a row, then I know that I
would be a zombie on the Friday. But now, a
five-day week, even if it would mean starting 7:00
every morning, although it rarely happens that I have
a week with only day-shifts, but if it did happen, it
would not feel as burdensome, because I know I get to
leave early. (assistant nurse, F: 257–270)
Several participants experienced that their sleep was
15. improved because they had less stress and ache in the
body and were able to sleep without needing to set
an alarm.
I don’t have this back pain, either, like I had
previously. It means that my sleep is better. (registered
nurse, D: 319–320)
I sleep in every day [laugh]. I don’t set the alarm. I go
to bed, and I sleep eight to nine hours every night, and
it is wonderful. So it feels like I am regaining the sleep
that I lost when I was working nights, because at that
time it was a constant nagging on the sleep. It just
happens. So now, I am rested in a way that I have not
felt in many years. (registered nurse, E: 135–142)
The time off between the shifts increased, which
meant an increased possibility for recovery outside work.
A consequence of this was being able to let go of work-
related thoughts.
If I work Monday and finish at 13:00 and then start,
perhaps I don’t start until 15:30 on the Tuesday or
12:30, and it is quite a long time in between where I
have time to rest and let go of thoughts about work.
(assistant nurse, F: 231–235)
Improved work climate
The workplace climate had improved, according to par-
ticipants. They also experienced more stability within
the group, as there were fewer people leaving or plan-
ning to leave the department. This was experienced as a
big change compared to previously.
I have been here for quite a long time, and there has
almost always been someone that has resigned,
16. sometimes several people… But now, and since the
summer, I don’t know anybody that has left because
they have resigned. I have always known that there are
people who are leaving, and this is the first time in a
very, very long time, I think, when this isn’t the case.
There has always been a big turnover rate. A
(registered nurse, A:444–459)
There was a better climate among the colleagues and
more joy and laughter at work, and the participants de-
scribed how they felt more of a group feeling.
I think we influenced each other as well, that
everybody was in such high spirits. A feeling of
euphoria in the whole group. (registered nurse, C:
555–558)
“Yes, I think there is more laugher, that people are
happier. It is a good atmosphere, for most of the time.
It is not always paradise, of course; there are many
individuals and there are conflicts here as well, of
course. But it feels like there is a happier atmosphere.
(registered nurse, E: 547–554)
If we get to keep this, and become a unified group, that
we… that is very pleasing. We had an after-work a
while ago and then one of the guys said that we are a
great gang now! Now it is cool, now it is stable! And of
course, I become happier when I feel that WE, we are
a large group of personnel, and we all work, we strive
after the same thing. This is fun. (assistant nurse, J:
605–614)
Some participants described that there was more col-
laboration within the department following the reduc-
tion of work hours, something that improved the quality
of the work.
17. I am working at a ward, and everybody works six
hours there, and you become a tight team that
particular day. So I do think we have become better at
Gyllensten et al. BMC Nursing (2017) 16:16 Page 5 of 12
collaborating, I do actually think so. When we have to
be more focused on what we do. (registered nurse, B:
62–65)
Effects of having no lunch breaks
The participants expressed that the value of having a
six-hour workday was higher than the loss of the
breaks. However, the lack of lunch breaks was defin-
itely a negative effect of the new work situation, par-
ticularly because of hunger. There were differences
among the participants regarding their ability to deal
with having to go longer without eating. Some got
used to it, while others found ways of eating during
the shifts.
[I]t is the only thing that can feel a little hard. And I
think it was hard in the beginning, because I am one
of those hungry persons (laughter). Here you can take
a break when it fits with the work. For example, on
the prosthesis side we should avoid opening the doors
too much. So we have coffee break very early, and then
I am very hungry. So this is something that I have got
used to… but is it the only thing that I have felt as
being a cost. But it is also worth it. I feel that it is
worth it. To know that I can go home at 13:00 and eat
then. (registered nurse, G: 216–228)
18. And it sounded heavy at first – omigod, is there no
lunch? – but it is so worth it. I get a little hungrier just
before lunchtime, but on the other hand I get to come
home straight after. Instead of sitting there and having
45-minutes’ unpaid break and going back to work
when the alternative is so much more appealing. I can
take it. (assistant nurse, F: 334–339)
We don’t have any break, but we have to be able to
eat. And that has also been a problem, because the
doctors have thought – have been a bit annoyed
because it is six hours, and when we say that we will
eat, they say that we should not eat. Such a miss in
communication. Of course we have to eat during six
hours, but we don’t have a break, and that is
something different. (assistant nurse, H: 340–346)
A negative aspect of removing the lunch breaks was
that the social contact at work was reduced. The par-
ticipants reported that they rarely got the chance to
meet colleagues in the same profession. And some
described how they missed talking to colleagues dur-
ing the lunch break.
Previously, it could be nice to have time to go to the
lunch room and sit down and talk to my colleagues.
So that is possibly a negative aspect, that this
particular time is gone. But it is so worth it. (registered
nurse, E: 194–198)
I think it is a little bit of a shame, this with the
social aspect. Eh… I think that some people stay
after they have finished, if they finish at 13:00, and
kind of stay on and eat lunch afterwards. So you
get a small part of it, but we rarely see each other,
anyway; as an operating nurse you are on your
own. You are the only operating nurse in the
19. operating theatre all the time, so you rarely meet
and get to speak with the other operating nurses.
(registered nurse, C: 299–314)
Working without taking breaks could make the work
appear more intense. Some participants described the
days as feeling much shorter than expected.
When you work six hours you got to keep going all the
time (snaps their fingers) until you go home…You do
something all the time, and I love it! Time flies. And it
never happens that I look at my watch to see what
time it is…but suddenly we get relieved and it is over.
(assistant nurse, J: 447–455)
So when we started with this six-hour day in November I
experienced that they days went fast. Time just disap-
peared, and six hours passed very quickly. Despite the fact
that we didn’t have any breaks we thought that the work
hours passed very quickly. (registered nurse, B: 20–24)
Improved work–life balance
The participants expressed that after the reduced work
hours were introduced they had a better balance
between work and leisure time, which meant more time
and energy for leisure activities and for non-work-
related everyday tasks. Moreover, the stress of everyday
life was easier to handle, and some experienced an
increased level of control in their lives, as they had more
control over what shift to choose. Finally, a few partici-
pants expressed that they now lived a more ideal life
compared to previously.
Energy for life outside work
Many expressed that there was more energy for life out-
side of work. Some expressed that work used to con-
sume all their energy and that there used to be no
20. energy left after work, whereas now there was energy for
both work and leisure time.
So I cannot see any disadvantage of working six
hours. I can only see advantages with it. I can work
full-time, I don’t wear down my body, I get a good
balance. I think that as a human you only have the
energy to work a certain part of the day…
Previously, all the energy went to work and there
was nothing left. Now there is a better balance, I
have the right amount of tiredness when I go to
work. (registered nurse, D: 480–492)
Gyllensten et al. BMC Nursing (2017) 16:16 Page 6 of 12
Several participants described having more time and
energy to spend time with family and friends.
I can say that I have more energy and desire to
meet people during the weekends when I am off.
Previously (before reduced work hours), I could feel
that I didn’t have the energy, you know. (registered
nurse, I: 178–182)
I do have the energy to call friends and spend time
with them. I still have the desire to do things – as
you do when you are not too tired. (registered
nurse; K, 148–151)
Shorter working hours meant more time and energy,
which some of the participants spent doing physical
exercise.
I am not physically tired, because I work six hours. I
21. still have energy in my body and can go to the gym
afterwards. (registered nurse, D: 85–86)
We work such short days, so we have time to do many
other things as well, I have time to do a lot of other
physical activity. I think that … my body is stronger
now, after a year, compared to when we started with
this. So… I have time to take care of my body. So I
don’t have massive pain in my shoulders and lower
back anymore. (registered nurse, B: 171–178).
Some used the extra spare time to relax on the beach.
[I]f I start at 15:30, then I cycle out to the sea and lay
there until 14:00, and then cycle to work. I get – it
feels like I have two days in one. I have the time to
have a whole lot of spare time and a whole lot of
work. (assistant nurse, J: 120–125)
Spending less time at work meant having more time to
do other things that needed to be done during the day,
such as dentist appointments and domestic chores. To
have the morning or the afternoon to deal with these
things appeared to create more flexibility, which made
everyday life easier and less stressful.
…I think I have a good balance. It feels like everyone
else says that they just work, that life is all about
work, but I don’t feel that way, anymore. Or, it is like
this: I have two parts, I have work and leisure time
every day… It is very nice actually. Today I will have
time to go to the shops, prepare for Christmas, and
clean, and then I will still have my two hours on the
couch. (assistant nurse, J: 621–630)
I have the time, and therefore I can plan these things,
talks with teachers, visits to the dentist. Normally, I
22. need to take time off… but if I start at noon, then I
have four hours before lunch… Even if I start at twelve
I am home at 19:00. So I am still at home in time to
eat dinner with my family and help at bedtime. So
from a family point of view this is great. (registered
nurse, C: 71–79)
Some participants related that they had previously ex-
perienced domestic stress relating to everything that
needed to be done outside of work, and that this stress
now was gone.
I feel that there is less stress… It is only positive,
there is nothing negative at all… I think that is the
greatest gain. Because to come home after four o
clock and start cooking food, and then there is
homework and stuff, suddenly the time is way too
much, and I should have managed to do a little
more… Time just flies. And it is not like that now.
(registered nurse, I: 509–521)
Another aspect of the reduced work hours was that
the participants who had previously worked part-time, in
order to manage everyday life, were now able to work
full-time. This had a positive effect on their pay and
pension benefits.
If I had worked here and it was eight hour shifts, I
would have worked part-time. Then I would have
worked 80% – I would not have managed to work
100%, eight hours – I would not have managed that.
Because then my daughter would be at nursery for a
very long time and it would have been… difficult. It is
tiring I have worked 100% as a nurse before I had my
child, at that was ok. But since then I have worked
23. part-time… Now I can work full-time with all that it
entails regarding pension and salary and so on, but
still have the advantages of reduced work hours. (regis-
tered nurse, F: 64–74)
Living life, not just surviving
All participants expressed that their life situation
had improved and that there was more time to do
what they really wanted. They appeared to be living
life in a manner that was closer to an ideal way of
living.
I feel that it must be a little bit more like this that
one is supposed to live. Instead of working all day,
going home and picking up tired children and what
not. No, I, because I feel that I have another form
of energy, I come home and it is afternoon and I
have time to be in the sun and take care of things.
And socialise, and spend time with the family.
(registered nurse, G: 602–612)
Gyllensten et al. BMC Nursing (2017) 16:16 Page 7 of 12
You get a life. I can say as much. You do get it,
actually – it is unbelievable what a big difference
these two hours make. (registered nurse, B: 460–465)
A consequence of gaining a better balance was the
experience of living a fuller life.
Everything is about work, and it is your life… Work is
a big part, but you still have to have the energy to live!
That is the primary thing, and if you have the energy
to live and feel that you have the energy to manage
24. things, then you are happy. And, of course, when you
feel good, that will have an influence on work.
(registered nurse, K: 61–167)
Consequences of being part of a project
The reduction of work hours within this department is a
time-limited project that was planned to run for two
years. It will be evaluated and possibly become a
permanent change. Because of this situation, the partici-
pants described uncertainty over the future of their
employment and the department. However, their
descriptions of the project were full of enthusiasm for
reduced work hours, and it was seen as a privilege that
they were willing to make sacrifices for.
Uncertainty over the future
Because the project is time limited, many participants
expressed that there was a feeling of uncertainty among
the staff. Many were worried about what would happen
in the future and predicted a high risk of staff leaving
the workplace if the reduced work hours were to be
discontinued.
If they stop this and decide that we will not continue
to get it (reduced work hours), anymore, then people
will flee this place… Because it is orthopaedic surgery
we are working with and many think it is demanding
work… so these six hours make up for that. (registered
nurse, D: 687–693)
I think things could turn out really bad for this
workplace if that were to happen (that reduced work
hours would be discontinued)… Because, as I have
said, this (reduced work hours) has raised the place so
much… I am not sure, but I think that many would
quit. (registered nurse, G: 322–327)
25. The main determinant of whether the project
would be continued was the cost-effectiveness of the
programme, according to the participants. Cost-
effectiveness in this context meant producing more
care to compensate for the increased costs linked to
reduced work hours. The participants believed that
the well-being of the personnel was not enough to
compensate for the increased costs.
It is not enough that we, the personnel, are satisfied, it
is not enough. Instead, it has to be shown, that we
have a high production, that it is worth it, to take care
of all people, so nobody should have to wait, and
nobody should have to be sent to other hospitals,
which costs money… That we can be cost-effective.
And that through this we can see that this is worth it.
(registered nurse, K: 43–49)
We have produced a lot more, but it is still money in
the end, and, yes, they have to do their estimations,
and so, I don’t know, nothing is certain. (registered
nurse, G: 316–320)
The belief that the economy was the most important
factor appeared to create an expectation of increased ef-
fectiveness and productivity, something that could lead
to feelings of stress.
[T]his is a project, and we are not sure that we get to
keep it. So I am on my toes, for sure, I don’t want to
laze around. I wouldn’t do that normally, either, but
do I hurry up. (assistant nurse, J: 414–419)
Now, there is a goal that we should become more
effective, we shall work, do more, because everyone
wants to keep the six hours… so then I do shape up
26. (assistant nurse, H: 134–137)
I know some that think that the pace is much higher,
that they feel more stress. That is not my experience…
Organisational change can be stressful, but here it has
been so positive. (assistant nurse, F: 535–538)
Privilege
A pervading theme in the participants’ accounts was the
expression of elation and enthusiasm for the reduced
work hours project. They described a feeling of being
chosen and having been given a privilege that they
wanted to make the best of.
I think we have a great situation… We say that
several times to each other, God, we got it so good!
Now we are going home at 1 p.m. Great! (assistant
nurse, F: 35–38)
Because it is still a sign of trust, a gift that we have
received, a possibility. That one wants to make the
best of. (registered nurse, K: 356–357)
Some of the participants stated that the new work
hours were such a positive change that it would be diffi-
cult to consider working anywhere else if the shortened
work hours became permanent.
A negative aspect was that – haa, now I can’t work
anywhere else, if I should ever have those thoughts,
because this is too damn good… I guess I get to stay
Gyllensten et al. BMC Nursing (2017) 16:16 Page 8 of 12
here (laughs), because it is difficult to give this up, as
27. it is fantastic. (registered nurse, E: 533–539)
I feel a little worried about whether I will ever dare to
leave this place if we get to keep the six hours… Will I
hold on to this and not dare (laugh), dare to move and
try something else? (registered nurse, I: 589–593)
A common theme in the interviews was that the
reduced work hours had meant so many positive things
in the participants’ lives that they preferred to endure
the negative aspects and problems linked to the reduced
hours rather than going back to normal working hours.
To go back and work nine hours … with a lunch, it is
not an option for me, if I get to choose this. Despite
nights and a non-existent management. Despite a lot
of different things, such as severely ill patients and
other things. (registered nurse, C: 334–337)
Personally, I think it is fantastic to work six hours. It is
intense and you don’t get a break, but that does not
bother me at all. So I think that in life this suits me
really well. (assistant nurse, H: 36–41)
There are a lot of great things with this… Some people
you don’t see for weeks, sometimes. But still I have to
say that I would not swap this for anything in the
world. I really hope it will be continued. (registered
nurse, B: 677–685)
Many of the participants experienced the reduced
work hours as something very positive, and they believed
that more people should have the opportunity to try it.
The more you look at it, the more you realise that this
is something that everybody should have… I think… I
do actually think that everybody experiences positive
28. effects from it. (registered nurse, D: 784–789)
I hope that it will be continued and that there will be
more that dare to try it. (registered nurse, G: 595)
Personnel and recruitment
The participants described how the reduced work hours
had involved hiring more staff to fill out the new shift
schedules. Previously, the department had had problems
recruiting and had needed to hire temporary staff from
staffing agencies. Several of the participants reported
that the reduced work hours were a big reason they
started working at the department. Another aspect that
was highlighted in the interviews was the possibility of
attracting new staff through reduced work hours rather
than with salaries.
It was actually this project that attracted me, to have
the opportunity to be part of it, to work six hours and
try that… So that was the crucial … that I applied
here. Mm, so I was here from the beginning when it
started. (registered nurse, K: 13–18).
To compete with the salary is not done that
much… rather it is, oh, how can we get the staff?
And it is so difficult within certain areas within
health care. It really is. And this is a fantastic way
of recruiting personnel. It is a big gain. (registered
nurse, K: 567–573)
Previously, they have not been able to recruit
people. They have had many, especially operating
nurses – there have been so many temporary
nurses from staffing agencies. And it must have
been expensive having them all. Now suddenly…
now they start to work, recently graduated,
though, but they are really great, those girls and
29. boys. They started recently five or six, and this
attracts people, it really does. (registered nurse, D:
677–685)
The participants described how the newly recruited
staff have had a positive effect on the atmosphere in the
department.
And it is people that have been attracted to this place
because of this… We, the people that have started are
bringing in an amazing energy and positive
atmosphere… that I believe has had a positive effect
on the whole department. And it is not only the case
that they can attract people – they can attract very
good people. (registered nurse K: 575–582)
Improved quality of care
All throughout the interviews the participants described
that there was an improvement in the quality of care
due to the new shifts that were introduced together with
the reduced work hours.
Several factors led to this improvement, including an
improved performance of the staff and better use of
available resources such as operating theatres.
Improved work performance
Some participants reported that they had improved
their work performance following the reduced work
hours. For example, they described being focused on
doing a good job during the operations.
You have one or two operations. And you got to
finish those. And you can do it really great. I do
think that I am doing a qualitatively better job now
compared to previously. I have always aimed to do
30. a good job, but I think that my work is even better
now, actually. I do actually believe this… because I
know that ‘This is the operation that I shall do,
then do it well.’(registered nurse, B: 277–283)
Gyllensten et al. BMC Nursing (2017) 16:16 Page 9 of 12
Some participants reported that the staff had more
energy following the reduced work hours and were
therefore able to engage more with the patients com-
pared to previously, when they were more tired.
I think that people were more exhausted and found
it more difficult to motivate themselves to do a
good job, compared to now. Now I believe that
several feel that they have the energy to engage with
the patients and do the job we are supposed to do.
(registered nurse, C: 641–643)
Several of the participants said that the new shifts
have meant fewer door openings during the opera-
tions, which decreases the risk for infection. In
addition, a further benefit of having fewer changes
of staff during the operations was the reduced risk
of misunderstandings and mistakes.
The fewer changes you have, the fewer times the door
is open, the fewer people that are involved, the less risk
of misunderstandings or something being forgotten or
misunderstandings. In fact, the more people that are
involved in something, the more potential mistakes.
(registered nurse, B: 116–121)
Effective use of available resources
31. The new shifts allowed the department to use the oper-
ating theatres during a larger part of the day, according
to the participants. Previously, the work had to be
wrapped up early in the afternoon, because the staff
were finishing work in the afternoon. The participants
proudly described how the department had increased its
activity and how the rooms were now better used.
[T]hen we had to… start wrapping up early at
several operating theatres so that we were done by
three o’clock, because people finished work at four
o’clock. And then you can’t start the next operation,
because it would take too long. So the operating
theatres were not effectively utilised, and that is
also a big cost… having them stand empty cost a
lot. (registered nurse, E: 320–330)
[T]he six-hour workday and the increased number of
staff has meant that we can open another operating
theatre… which means that our activity has increased.
(registered nurse, E: 390–392)
In addition, the participants experienced that the time
they spent at work was used more efficiently compared
to previously. The time they called ‘wasted’ had been re-
duced, and the elimination of breaks meant that they no
longer needed to replace each other during lunch breaks,
something that used to take a lot of time.
I was going to replace her (during a surgical
procedure)… And then I had to get into the work and
all the equipment that is needed for the operation, and
then she comes back forty-five minutes later… and
then I would go out again and report to her what has
happened during the hour. No it was not good. This
way is much better. Now I replace her and she goes
32. home, and I stay until it is finished. (registered nurse,
D: 246–257)
In my experience we are more effective than when we
worked eight hours. Because it was a lot of looking at
the watches: ‘Oh, soon there is lunch,’ a little bit like
that. (registered nurse, B: 74–77)
Discussion
The current qualitative study investigated the experi-
ences of reduced work hours and no lunch breaks
among nurses and assistant nurses at an orthopaedic
surgery department in Sweden. Four main themes with a
number of subthemes were found in the interview data.
The main themes were A more sustainable working situ-
ation, Improved work–life balance, Consequences of
being part of a project, and Improved quality of care. All
participants in the study appeared to view the reduced
work hours as a positive change at work.
‘A more sustainable working situation’ consisted of a
number of subthemes, including ‘Improved recovery’.
According to the participants, working shorter days im-
proved recovery in several ways. Work consumed less
energy because the participants spent less time at work,
and there was more time for recovery before and after
the work shifts. Thus, the workdays were shorter and
the periods outside work were longer, which created
good opportunities for continuous recovery from work.
Indeed, previous research has found that daily recovery
is more important for health than longer vacations. The
positive effects of a vacation quickly disappear [16].
However, in the present study the lunch breaks were
eliminated, and shorter breaks/pauses were not guaran-
teed. In the subtheme ‘Effects of having no lunch breaks’
the participants reported that the reduced work hours
compensated for the lack of breaks. The lack of breaks
33. was not described as a big problem for the staff. A rea-
son for this could be that the staff had been involved in
the planning of the new work hours and shifts, which
meant that they had a certain level of control over the
work situation. The lack of breaks most likely involved
intensifying work, which can have negative health ef-
fects. In a study with driving instructors it was found
that removing shorter breaks and intensifying the work
had negative effects on sleep and cognitive performance
[12]. However, the work hours were not reduced in that
study. In addition, a study with social workers found that
reduced work hours had a positive effect on restorative
Gyllensten et al. BMC Nursing (2017) 16:16 Page 10 of 12
sleep, sleep quality (on weekends), stress, sleepiness, and
fatigue and exhaustion (both on workdays and weekends).
Moreover, instrumental manager support was also affected
positively, which is somewhat in accordance with the
present study, which found an improved work climate [6].
In the main theme ‘Improved work–life balance’ the
participants described an improved balance between
work and leisure time. Improved balance between work
and life involved several aspects, such as more energy to
do things during leisure, time including increased social
activity and exercise. Indeed, a previous study on the ef-
fects of the six-hour workday, for female health care and
day care personnel, found that the biggest effect was in-
creased time for social activity [8]. However, the same
study did not find an increase in exercise. The partici-
pants in the current study also reported that it was eas-
ier to handle the everyday stress with children and
family commitments following the reduced work hours
34. and that they experienced an increased control over
working hours. The previously mentioned study found
that reduced work hours had a positive effect on work
intrusion on private life [6]. Previous research has shown
that a poor work–life balance, regardless of gender, is re-
lated to having more health problems compared to em-
ployees with a good work–life balance [18].
‘Consequences of being part of a project’ was a main
theme related to the fact that the reduced work hours pro-
ject was introduced on a temporary basis with no definite
end date. The participants reported experiencing uncer-
tainty and worry over what would happen in the future
expressed a strong wish for the project to continue. The
uncertainty and lack of control regarding what would hap-
pen with the working situation in the future appeared to
lead to worry among the participants. Indeed, control is
an important factor in well-being at work, and lack of
control can have negative effects on health [19].
The final main theme was ‘Improved quality of care’,
which described how the participants reported that they
had improved their performance and that the depart-
ment’s resources were used more effectively following
the reduced work hours. Indeed, increased production
and employee health do not need to be the only mea-
sures of the effects of reduced work hours. Quality of
care could also be a relevant outcome measure. The pre-
liminary results in the evaluation of a six-hour workday
at a nursing home for the elderly in Gothenburg munici-
pality found that the assistant nurses experienced that
they were providing better care [10]. Another study that
evaluated reduced work hours compared to physical
activity at work found that the group that had reduced
work hours had improved their productivity more than
the group that did physical activity [9].
35. There are several limitations with this study, one being
the low response rate, with only 10% of the members of
staff agreeing to take part in the study. It could be the
case that the participants who agreed to take part were
the members of staff that were particularly positive or
negative towards the project. It is also possible that the
participants wished to portray the project in a good light
during the interviews for fear of a negative evaluation of
the project. These risks need to be considered, but the
interviewers were very aware of these possibilities and
asked about both positive and negative aspects of the
participants’ experiences. In, addition a structured inter-
view questionnaire could have assisted the data analysis.
Transferability is important to consider in qualitative
studies. Issues such as the sample and number of groups
and interviews need to be considered. The sample con-
sisted of individuals who worked as nurses or assistant
nurses with reduced work hours at a particular depart-
ment. Only a small proportion of the staff at the depart-
ment took part in the study, so it is not possible to say
that the findings represent all individuals. However, this
is in accordance with the method of IPA, where studies
are conducted with small sample sizes, and through pur-
posive sampling a group of participants is found for
whom the research question is significant [17]. Regard-
ing generalisability, it could be said that if the study has
identified an experience, it could be similar for many
others. For the current study it is also important to re-
late the finding to previous studies (see above) and
thereby add to the accumulation of results regarding the
experience and effects of reduced work hours [20].
Possible implications of these findings are that the re-
36. duced work hours could help to create a more
sustainable working situation for nurses and assistant
nurses. There may be positive long-term effects on both
physical and psychological health that is not yet evident.
Reduced work hours increase the possibility for suffi-
cient recovery between the shifts. However, some
participants found it difficult to work a whole shift with-
out a break (although they still thought it was worth it),
and for future studies it could be important to consider
the issue of recovery or lack of recovery while working
for six hours without a break. Perhaps a formal system
for food intake during the shifts could be useful. There
have been difficulties recruiting nurses within this par-
ticular region, and another implication could be that
implementing reduced work hours is a way to create
an attractive place of work for nurses that would
make the recruitment process easier. This particular
hospital could not compete for staff with higher
salaries than other departments, so offering reduced
working hours could be one effective way to attract
skilled personnel. Furthermore, the participants
expressed that they were now able to provide better
care for their patients, and this could also be a pos-
sible effect of reduced work hours.
Gyllensten et al. BMC Nursing (2017) 16:16 Page 11 of 12
Implications for nursing practice research is that
future studies should evaluate short- and long-term
individual and organisational effects of reduced work
hours including quality of care. Considering this is a
qualitative study, that cannot be generalised to the same
extent as larger quantitative studies, further studies are
needed to draw firm conclusions regarding the effects of
37. reduced work hours and to make suggestions for nursing
practice research.
Conclusions
The present study explored the experiences of a number
of nurses and assistant nurses who had reduced work
hours. Four main themes were found: A more sustain-
able working situation, Improved work–life balance,
Consequences of being part of a project, and Improved
quality of care. Overall, reduced work hours appeared to
have many, mainly positive, effects, in both work and
home life.
Acknowledgements
The authors wish to thank all the participants who contributed
to this study.
Funding
This research received no specific grant from any funding
agency in the
public, commercial, or not-for-profit sectors.
Availability of data and materials
The data from this article may be requested at no cost from the
first author.
Authors’ contributions
KG designed and planned the study. GA and HM conducted the
interviews.
All authors analysed the data. KG wrote the manuscript drafts.
All authors
reviewed manuscript drafts and approved the final version.
Competing interests
The authors declare that they have no competing interests.
38. Consent for publication
Informed consent to participate in the study was obtained from
all participants.
Consent for publication was obtained from all participants.
Ethics approval and consent to participate
The study was approved by the Regional Ethical Board in
Gothenburg
(Regionala Etiksprövningsnämnden i Göteborg) diarienummer
698–15.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional
claims in
published maps and institutional affiliations.
Author details
1Department of Occupational and Environmental Medicine,
University of
Gotenburg and Sahlgrenska University Hospital, Gothenburg,
Sweden.
2Department of Psychology, University of Gotenburg,
Gothenburg, Sweden.
Received: 27 September 2016 Accepted: 23 March 2017
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Gyllensten et al. BMC Nursing (2017) 16:16 Page 12 of 12
http://dx.doi.org/10.1093/bjsw/bct036
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AbstractBackgroundMethodsResultsConclusionsBackgroundMet
hodBackgroundParticipantsProcedureData analysisResultsA
more sustainable working situationEnergy for workImproved
recoveryImproved work climateEffects of having no lunch
breaksImproved work–life balanceEnergy for life outside
43. workLiving life, not just survivingConsequences of being part
of a projectUncertainty over the futurePrivilegePersonnel and
recruitmentImproved quality of careImproved work
performanceEffective use of available
resourcesDiscussionConclusionsAcknowledgementsFundingAva
ilability of data and materialsAuthors’ contributionsCompeting
interestsConsent for publicationEthics approval and consent to
participatePublisher’s NoteAuthor detailsReferences
Municipal Night Nurses’
Experience of the Meaning
of Caring
Christine Gustafsson, Margareta Asp and Ingegerd Fagerberg
Key words: care of older people; caring in nursing;
gerontological care; night nursing;
phenomenological hermeneutics
The aim of this study was to elucidate municipal night
registered nurses’ (RNs) experi-
ences of the meaning of caring in nursing. The research context
involved all night duty
RNs working in municipal care of older people in a medium-
sized municipality located
in central Sweden. The meaning of caring in nursing was
experienced as: caring for by
advocacy, superior responsibility in caring, and consultative
nursing service. The muni-
cipal night RNs’ experience of caring is interpreted as meanings
in paradoxes: ‘being close
at distance’, the condition of ‘being responsible with
insignificant control’, and ‘being
interdependently independent’. The RNs’ experience of the
44. meaning of caring involves
focusing on the care recipient by advocating their perspectives.
The meaning of caring
in this context is an endeavour to grasp an overall caring
responsibility by responding to
vocational and personal demands regarding the issue of being a
RN, in guaranteeing
ethical, qualitative and competent care for older people.
Introduction
Older peoples’ need for care is expected to increase in line with
changes in life ex-
pectancy and variation in the patterns of diseases over the next
50 years.1–3 There is an
increasing prevalence of age-related morbidity and disability in
the European popu-
lation.4 Older people experiencing multiple functional decline
combined with a need
for medical care require a mix of services from multiple
providers.5 Key contributors
to Swedish municipal care are night nurses who provide nursing
care and medical ser-
vices during the night to large groups of older people in
community facilities. Nursing
has changed significantly in recent decades, which will continue
in the future, with
nurses taking on different roles, especially in the long-term care
of older people.6 In
many western countries care for older people is being
transformed from a health care
model towards a social care model.7 This study concerns
municipal night nurses’
experiences of the meaning of caring in nursing.
Address for correspondence: Christine Gustafsson, Mälardalen
University, School of Health
46. Care of older people from an international perspective
The municipal nursing of older people in Sweden comprises
care in special forms
of housing, nursing homes and other community-based settings
or home care.13–15
Registered nurses’ (RNs) care of older people includes
characteristics of both long-
term16 and palliative17 care around the clock and is defined as
gerontological nursing18
and community nursing.16 RNs’ night care is different from
day-time care.19 Today’s
RNs’ night-time care of older people often entails administering
treatments and under-
taking activities also associated with day-time care.13,18 In
Sweden, the role of RNs who
work in the social care context appears different when compared
with the hospital
context.
Swedish municipal care for older people
Swedish municipal care for older people is regulated by two
separate laws. The Social
Services Act20 governs care mangers, residential home mangers
and care staff (en-
rolled nurses and nurses’ aides). The Health and Medical
Act21,22 regulates RNs and
physicians. RNs may delegate care staff23 to carry out nursing
care.21 Care staff are, by
definition, on the same organizational level as RNs. This means
that RNs do not have
any authority regarding the provision of social care, nor are
they staff leaders.24,25 In
2006, 4.7% (12 200) of staff working in the municipal care of
older and disabled people
were RNs.26 No data are available for exclusively night-duty
RNs.
47. To ensure appropriate care, RNs are employed in municipal
social care21 and also act
as supervisors for care staff.27 These RNs have responsibility
for large groups of older
people, especially during the evening and at weekends,27,28
and for even larger groups
during the night. Care staff provide overnight care while RNs
rarely provide bedside
care. Unlike night RNs caring for older people in the UK15 and
the USA,29 Swedish
RNs have a telephone consultation function. Every area of the
municipal social care
of older people is covered by day/evening duty RNs who are
responsible for different
caring units. These RNs call the night duty RNs to report any
care recipients who will
need nursing care or a visit during the night. The night duty
RNs work in pairs, and
for about 15 minutes they will receive telephone reports from
their different areas of
nursing responsibility. They then prepare summaries and a
schedule for their planned
visits. When an RN is required in a central residential home the
two nurses normally
Municipal night nurses’ experience of the meaning of caring
601
Nursing Ethics 2009 16 (5)
go together. When a unit on the outskirts of the town requires a
RN visit, they split
up because they must arrive at any calling unit within 30
48. minutes. The RNs can have
approximately 30–50 telephone consultations during one night
and a total of about 15
nursing visits (two or three of these may be visits to care
recipients who are at the end
of life).
The RNs’ working conditions are described in terms of being on
call to support and
direct care staff and, on request, to arrive at a calling unit
within 30 minutes. Tasks of
planned advanced medical care and contact visits to persons
being cared for at the end
of their life are also included. For support, the RNs can contact
the district physician on
call. The RNs can also make referals to the hospital emergency
department.
The RNs’ nursing responsibility includes all outpatients
enrolled in home care and
supporting care staff in assisting old people with alarms. They
are also accessible for
both planned advanced medical treatments and unplanned
nursing needs in the muni-
cipal catchment area. Two RNs have nursing responsibility for
the night-time care
needs of approximately 2700 people.
Rationale
Little research has focused on nursing provided at night.30–32
Existing studies have
mainly described RNs’ work in hospital settings32 rather than
in the municipal, social
care context. An expected increase in the need for RNs to care
for older people in
special forms of housing, nursing homes and other community-
49. based settings or home
care suggest the importance of investigating nurses’ caring at
night. This is particu-
larly important when there is nursing responsibility for large
groups of older care reci-
pients. When conceptualizing caring as ‘the ethical life of
nursing’,8 questions about the
meaning of caring in nursing are justified: What is caring in
municipal night nursing?
How do night RNs who provide nursing and medical services to
large groups in the
community experience caring? The aim of the present study was
to elucidate municipal
night RNs’ experiences of the meaning of caring in nursing.
Method
Understanding the meaning of people’s lived experiences in new
and different ways
and explaining them in a better way may open up opportunities
for people to live better
lives. According to the French philosopher Paul Ricoeur,33
lived experience remains
personal but its meaning can be transmitted through the
interpretation of narratives.
The aim of the interpretation is to reveal the meaning in a text,
that is, to interpret the
world that is opened in a text. Its meaning is not created by our
interpretation; it is
already in the world. Through the interpretation of texts we can,
however, learn more
about world phenomena.
A phenomenological-hermeneutic method, inspired by
Ricoeur33,34 and developed
by Lindseth and Norberg,35 was used for the text analysis. The
aim of this method is to
50. interpret (i.e. to elucidate and understand) the meaning of a
phenomenon as it emerges
from the text.34 The scientific openness of Gadamer’s
philosophical hermeneutics,36 as
well as Ricoeur’s33 distancing, questioning and critical
approach, influences the inter-
pretive process.
602 C Gustafsson et al.
Nursing Ethics 2009 16 (5)
Setting and participants
The research context involved all seven night duty nurses
working in the municipal
care of older people in a medium-sized municipality (90 000
inhabitants) located in
central Sweden. All-night RNs in this district also participated
in a larger project ex-
ploring municipal night nursing. The RNs were all women who
were experienced in
the profession, having worked for 6–35 years in various nursing
contexts. At the time
of the data collection for the present study, two participants
withdrew owing to illness
or termination of employment.
In January 2006, the participants had nursing responsibility for
21 units for older
people in sheltered housing. They also had nursing
responsibility for 25 special hous-
ing units for disabled persons. During collection of the data
(January–May 2007) the
RNs reported increased nursing responsibility that included all
51. outpatients enrolled in
home care, support for care staff assisting older people with
alarms, and having to be
accessible for unplanned nursing needs in the municipal
catchment area.
Data collection
The first author (CG) conducted open, tape-recorded interviews
with the participants.
Follow-up questions varied between the interviewees,
depending on the individual
narratives.37 The interviews lasted for between 55 and 120
minutes and were conducted
in privacy at the local university. The questions were chosen to
cover relevant aspects
of the participants’ experience of caring in nursing by asking
the following opening
questions: What does caring mean in municipal night nursing?
How do you experience
caring in your work?
Ethical considerations
Permission for the study was obtained from the staff manager
responsible for the RNs
in the municipal organization. The study was approved by the
Regional Ethics Board
in Uppsala (ref. 2004-Ö-437).38 Participating RNs were
guaranteed confidentiality and
were offered supportive guidance, but none requested this.
The general rules for good research practice concerning
honesty, openness, con-
sideration of research value and impartiality were
respected.39,40 More specifically, the
study was also considered appropriate to satisfy the research
criteria of risk–benefit
52. assessment,40,41 importance and quality, and protection of
individual participants.39,42
Interpretation process and results
The process of interpretation of the transcribed interviews was
guided by a phenomen-
ological-hermeneutic analysis using three phases: naive reading,
structural analysis
and comprehensive understanding.35 Each interview transcript
was read several times
in order to grasp its meaning as a whole (naive understanding).
A structural analysis
was performed and, in a process carried out by the first and
second authors, related to
the naive understanding in order to elucidate the different parts
of the text. Initially the
text was split into meaning units defined as a piece of text of
any length that expressed
a meaning of caring in nursing. The meaning units were
condensed and reflected upon
to identify similarities, variations and differences, and then
used to create subthemes.
Municipal night nurses’ experience of the meaning of caring
603
Nursing Ethics 2009 16 (5)
These subthemes were then grouped into themes by reflection
and abstraction35 (Table 1).
During this process of structural analysis, the naive
understanding was reconsidered
and revised.
53. Table 1 Examples from the structural analysis
Meaning unit Condensed meaning
unit
Subtheme Theme
When you enter an old person’s room
at a unit, you do not just rush into the
room, turn on the light and speak loudly,
deliver the injection and then leave. You
have to be careful, knock on the door,
try to speak to the person in the bed, and
ask how he or she is experiencing the
problem. I also always take my jacket off
before I enter the room.
In caring for the care
recipient the nurse is
deliberately careful
and aware of the care
recipient’s well-being
and comfort.
The nurse does not just
enter a room, turn on the
light, do her nursing task
and then leave.
Considering
care
recipients’
perspective
Caring
for by
54. advocacy
You kind of try to have your eyes open,
to see the person behind the disease,
but also to see relatives and the care
staff ... to see wider and observe more
than just the task you are there for ...
to see the whole situation ... it is to see
relatives, the care staff ... in this case,
they had not succeeded in checking the
blood glucose, they did not understand
the blood glucose machine ... and this
was something I discussed with them
afterwards ... I mean it was correct of
them to give the man sugar cubes, they
understood he had hypoglycemia, they
were not sure, but anyway they gave
him sugar, and that was good! I mean
it is better to do that than to do nothing
... anyway they did handle the situation
and it is about giving support and
paying tribute to their actions.
It is a nursing process to
be open, observant of the
whole situation, to see
the person behind the
disease.
Not to ignore the
complex situation.
To observe the care
recipient’s comfort,
the relative’s situation
and care staff’s caring.
55. Trying to figure out the
needs for all involved
in preparing a caring
situation.
Considering
situations
in wider
perspectives
If I observe, for example, medicine that
does not work, or if it is care staff who
do not understand how to care or, in
some way I tell them how I want it to be,
or how I think the care recipient would
like to be cared for ... that is what I do
... In some way I think I more and more
have to stand up for the care recipients to
protect them from relatives’ ideas of how
the care should be ... actually, nowadays,
some relatives have many strange
ideas and like to consider themselves
as the ones knowing what is best care
... and somewhere there you have to be
courageous and tell them that ... NO ...
The care recipient’s well-
being, needs and comfort
are prioritized ahead of
relatives’ or care staff’s
requests.
Caring with
a prioritized
care
recipient
56. focus
604 C Gustafsson et al.
Nursing Ethics 2009 16 (5)
Meaning unit Condensed meaning
unit
Subtheme Theme
In my work the most important thing
is to make sure that the care recipients
are given proper care, that I am doing
my best every time I make a nursing
contribution and that I have courage to
act when I observe something wrong or
insufficient care.
The main function in
nursing is to guarantee
care, the recipient’s
well-being and doing
one’s very best every
time when caring for
someone.
To have courage to take
charge when observing
insufficient caring.
Protecting
and
guarding
57. care
recipients’
rights
Table 1 (Continued)
Each interview text was then read again as a whole and related
to the naive under-
standing and the findings from the structural analysis. It was
then reflected upon in
discussions with all three authors, resulting in an interpretation
of possible meanings
of caring in nursing. From the interpretations a comprehensive
understanding was
formulated, which took into account the authors’ pre-
understanding (see ‘Critical
considerations’ section).
Naive understanding
A naive understanding was formulated linked to the structural
analysis, as follows.
Caring is a fundamental stance exercised in nursing activities by
RNs, meaning caring
advocacy of care recipients in encounters, nursing actions and
nursing service. A caring
stance means that the care recipients’ rights are considered and
given priority ahead
of the requests of others. Prioritization in nursing exists in an
implicit hierarchy giving
caring precedence in the following order: care recipients,
relatives and care staff.
Caring in night duty nursing is initiated by other staff or
relatives’ cell phone com-
munication in informing and consulting the RN. ‘Caring for’
58. means mediated caring in
a triad with care staff (or relatives), that is, this type of caring
in nursing means remote
caring, being on alert and supporting backup care staff (or
relatives) in caring for care
recipients. These RNs’ remote caring dimension with superior
caring responsibility
makes the process of emphasizing and expressing the care
recipients’ perspectives
easier by advocacy in guarding their needs, well-being and
dignity ahead of those
of care staff (or relatives). ‘Caring about’ has a preventive
dimension in developing
confident relationships with care staff and relatives, and caring
service mainly implies
RNs’ medical services.
Structural analysis
In the following sections the meaning of caring is described
according to the three
themes: caring for by advocacy; superior responsibility in
caring about; and con-
sultative nursing service (Table 2).
Municipal night nurses’ experience of the meaning of caring
605
Nursing Ethics 2009 16 (5)
Caring for by advocacy
Caring for care recipients, relatives and care staff means
attending to persons in need of
a RN consultation. This includes both direct caring encounter
59. situations and telephone
consultations mediated by care staff or relatives. The primary
persons cared for are the
care recipients, which means that their perspective is constantly
taken into account,
although care staff’s or relatives’ problems may be the reason
for the consultation.
Caring for by advocacy means prioritizing care recipients’
perspective, and caring
encounters being achieved in a hierarchical fashion. This
hierarchy means that care reci-
pients’ needs are given precedence, followed by those of
relatives. Finally, care staff’s
problems and needs must be considered.
Caring for by advocacy is related to respecting care recipients’
basic human rights
such as dignity, integrity and autonomy. It also means reflection
on care recipients’
problems using a broader perspective (their life situation).
Assessments in caring
situations imply caring while endeavouring to see the person
behind the disease/con-
dition. Here, caring means understanding the situation by
stopping and reflecting, and
using nursing experience to consider the problem combined with
the RN’s own life
experiences:
... you kind of try to have your eyes open, to see the relatives
too; I think you have more ...
I believe it is a process of maturing, looking more broadly than
just at the problem.
Having concern for the care recipient can often mean leaving
60. direct caring actions to
the care staff who are familiar to the care recipient. Experience
and knowledge facilitate
understanding of care recipients’, relatives’ and care staff’s
situations.
Table 2 Subthemes and themes describing municipal night RNs’
experiences of the
meaning of caring in nursing
Subtheme Theme
Caring with a prioritized care recipient focus
Protecting and guarding care recipients’ rights
Considering care recipients’ perspective
Considering situations in wider perspectives
Caring for by advocacy
Caring at a distance
Co-operating and collaborating with care staff
Adopting a superior caring responsibility
Prioritizing problems requiring a nurse
Being accountable for care staff’s caring
Supporting and supervising care staff‘s and relatives’ caring
Advising care staff and relatives by confidence and courage
guidance
Superior responsibility
in caring about
Caring during brief encounters
Assessing needs and problems
Caring with extensive nursing experience
Caring with a range of problems
Giving service in advanced medical treatments
61. Giving medical service in advanced medical treatments
Consultative nursing
service
606 C Gustafsson et al.
Nursing Ethics 2009 16 (5)
Caring during life’s final stages means contact visits to
guarantee care recipients’
well-being, signify accessibility, and offer further contact
between relatives and care
staff. Caring for aggressive and anxious people with dementia
means allowing flexi-
bility with the care recipient and striving to attain the best
possible treatment for the
condition while giving support to care staff in a difficult
situation.
Superior responsibility in caring about
Caring about care recipients, relatives and care staff by superior
responsibility means
adopting vocational accountability by virtue of being a RN.
Caring about implies a
more remote and distanced caring, excluding direct care and
caring encounters. Caring
about concerns situations in which RNs’ caring is negotiated,
which are triadic with
care staff as mediators.
Caring in the current context means responsibility in preparing
propitious conditions
62. for night caring by co-operation, collaboration, and supporting
and supervising care
staff or relatives.
... that you are explicit in terms, they should know that you are
there for them, there is a
nurse with superior responsibility. If there are any questions or
something they would like
to discuss they should turn to me through the care staff, because
I am seldom at the unit ...
Collaborating with care staff also means managing staff, and
sometimes directing
how caring is to be employed. In RNs’ adoption of a superior
caring responsibility,
car ing about may be seen to benefit from RNs rarely
participating in bedside care. This
facilitates supervision by RNs and sometimes involves care
staff in discussions of how
to care for care recipients. A superior caring responsibility also
includes estimating
care staff’s competence in dealing with delegation and
instructions.
The focus on care recipients requires, in some cases, teaching
care staff to provide
competent care. A superior caring responsibility also means
having a mandate from
care staff concerning decisions, instructions and actions to
solve problems that have
been raised. Superior accountability and requiring a mandate
imply that RNs need
confidence and courage in the nursing profession. The authority
function also means
adopting an overall caring obligation entailing removing
responsibility from care staff
63. or relatives by taking charge of a particular problem:
I must be explicit, to inform relatives about the situation, this is
what we can offer and
what we will do, and there is a kind of response reflecting their
understanding about the
expected course of events ... in some way I give them a part of
me as a professional nurse
... to be there at hand, and in my view, approach to care for the
care recipient, and also to
care for the staff ...
Caring about also includes a prioritizing dimension, signifying
assessment and
prioritization of when a face-to-face RN consultation is needed.
This is enabled
by support from other caring team professionals’ and the
organizations’ models of
prioritization. Caring about by superior caring responsibility
means striving for caring
advocacy in facilitating quality and competent night care for
older people.
Consultative nursing service
Providing a night nursing service to care recipients, relatives,
care staff and clients
of a municipal organization means that RNs must be on the alert
to respond to acute
Municipal night nurses’ experience of the meaning of caring
607
Nursing Ethics 2009 16 (5)
64. problems and needs requiring RNs’ skills, competence and
authority. The nursing
service mainly has the characteristics of medical services, also
including planned
activities ordered by clients of municipal social care.
... it can be various treatments in private homes, for example,
parenteral nutrition via a
port-a-cath [a subcutaneous central venous catheter], peritoneal
dialysis, or vacuum
pumps for leg ulcers.
These nursing tasks mainly involve advanced medical technical
treatments neces-
sitating the contribution of a RN.
The on-call dimension entails nursing consultations during brief
encounters con-
cerning the assessment of problems and needs, the use of
advanced medical equip-
ment, and planning approaches to a broad range of difficulties.
These consultations are
initiated by care staff observing a problem, leading to arranging
a telephone consulta-
tion and RNs often giving a prescription and instructions and/or
delegation to the
care staff in how they are to deal with the situation. When night
RNs’ consultations
mean encountering a care recipient, relatives or care staff, this
consists of intense brief
assessments during which the whole situation is taken into
consideration.
... I have more demands on me when I enter a caring situation
where I do not know
65. anybody ... I have to do my assessment in 10 minutes and give
the impression of not being
stressed, of having a genuine interest in how they are (relatives
and care staff) and the
care recipient’s condition. Rapidly, I have to create a picture,
give some kind of sense of
community, make them feel confident ... it starts when I enter
the door. I have a nurse’s
role in encountering relatives, you always have two paths or ...
more ... you have to sense
which to choose ...
A consultative nursing service implies a requirement for
confident RNs with
extensive nursing experience. Basically, night nursing care is an
interdependent
phenomenon. The initial stage is observation of a problem by
care staff leading to a RN
consultation and the RN’s assessment and decisions concerning
confidence in care staff
to take further action.
... you have to trust the care staff because you do not have time
... you cannot be
everywhere.
In this way, caring in nursing means a state of contradiction,
existing in an inter-
dependent independency, including both RNs’ and care staff’s
independence in caring
actions as well as dependency on communication, competence
and attention to an
identified problem.
Comprehensive understanding and reflection
Comprehensive understanding is based on the naive reading, the
66. themes and sub-
themes, the authors’ pre-understanding, reflections related to
the context of the study,
the research question and the literature.
Municipal night RNs’ experiences of caring in nursing are
interpreted as paradoxes:
‘being close at a distance’ and the conditions of ‘being
responsible with insignificant
608 C Gustafsson et al.
Nursing Ethics 2009 16 (5)
control’ and ‘being interdependently independent’. The themes
emerging from the
structural analysis seem to be connected and intertwined with
each other, illustrating
the complexity of the phenomenon under study.
It could be suggested that caring may be considered to comprise
RNs’ all-nursing
activities. On the other hand, the participant RNs experience
caring as a fundamental
and basic stance in night nursing. Conversely, caring is often
associated with and
described in terms of relationships and encountering the care
recipient.10,43–45 However,
that these RNs seldom physically meet care recipients does not
mean a lack of caring.
The philosopher Marcel46 discusses the concept of being co-
present. Marcel explains
that encounters can also occur at thought level. An encounter is
not merely to cross
67. someone’s path, it is also to be near to or with them. Municipal
RNs’ night caring may
also occur at thought level. This means thought while near to or
with the care reci-
pient. Consequently, the caring stance is important despite the
lack of a meeting that
could be discussed in terms of nursing ethics. The caring stance
can also be viewed
in relation to the work of Marcel,46,47 who examined ‘being’
and ‘having’ in a variety
of contexts. When applied in the study context, the RNs’ caring
stance means caring
is more important than having a caring attitude. The RNs
thereby think and narrate
caring with the care recipient as a natural focus taking
precedence over the problems
of both relatives and care staff. This means that, in caring, the
RNs strive ‘to be close at
distance’ because by their actions they deliberately advocate the
care recipients’ needs,
well-being and dignity. The needs, well-being and dignity of
relatives and care staff,
are considered at a subordinate level. This deliberate focus on
care recipients emerges
as caring advocacy.
Advocacy is a central concept in nursing ethics48 and also in
gerontological nurs-
ing.13,18 Caring advocacy is also in line with a caring science
approach, which emphasizes
the patient’s perspective.10,43,44 In the present study, caring
advocacy was stated to be
a feature for protecting care recipients’ dignity, well-being and
caring needs, as also
noted in the literature.48,49 If their condition seldom permits
care recipients to consult
68. RNs this is mitigated by the triad formed by care staff (or
relatives) being mediators in
the communication process between RNs and care recipients.
This means that despite
the night duty RNs’ distance from the care recipients, it is easy
to advocate for this
group, in spite of the fact that they are mainly frail older people
not capable of involve-
ment. Similar situations have been discussed50 when studying
telecare, which also has
emphasis on the importance of having experienced care staff as
intermediaries in the
communication process.
Van Hooft8 considers the concept of caring in nursing
connected to moral theory by
virtue ethics, which is neither merely an interpersonal emotion
nor just a professional
practice; it is the ethical foundation of nursing. A RN who
demonstrates phronesis (an
Aristotelian concept meaning ‘practical wisdom’) will feel
caringly, think caringly and
thereby act virtuously.8 In the results presented in this article
RNs deal with medi-
ated care carried out by care staff, which seems to call for a
nursing quality of clinical
wisdom43,51,52 or phronesis.53 The concept of clinical wisdom
is complex, being related to
advocacy in preserving care recipients’ dignity. There is also a
stated need for skills of
sensitivity, patience, trust, compassion, ethical discernment and
clinical competence in
the care of older people.43,52,54,55
Night RNs are consequently dependent on care staff and
relatives to guarantee
69. good nursing care for older people; that is, they are responsible
but have insignificant
control. They want to give, and are responsible for, good quality
care21,56 that they do
Municipal night nurses’ experience of the meaning of caring
609
Nursing Ethics 2009 16 (5)
not administer themselves and over which they have
insignificant control. This leads
to a high risk of work-related stress28,57 and can be a reason
for moving away from
caring for older people.58,59
The difference between caring for and caring about stands out
in the findings.
Caring for means a care recipient focus despite the RNs’ remote
function. This can
be considered as an individual characteristic founded in self-
knowledge by a process
of vocational maturity and incorporated into these RNs’ being
and their meaning of
caring. Ricoeur33,60 acknowledges that the self is not a simple
subjective entity. It is in
some part a social construct, and an important source of such a
construction of the self
is the role we occupy in society. This van Hooft12 exemplifies
as especially clear in the
case of the nursing profession. For the RNs, caring is not just a
matter of doing the job
effectively by looking after sick people, it is also a matter of
having a compassionate and
70. benevolent attitude towards them. The care recipients and the
RNs are, in many ways,
dependent on the care staff (or relatives) owing to decisions that
have to be made about
if and when RNs are to be consulted. This is the situation of
being interdependently
independent. The RNs are independent in the execution of their
professional practice,
making their own self-governing assessments and decisions. At
the same time they are
dependent on the skills of care staff and/or relatives to observe
problems and also to
perform the RNs’ instructions and delegated care. It is also
illustrated in the findings
that the night duty RNs seldom participate in bedside nursing,
which is instead exer-
cised by relatives or care staff. The RNs’ caring thus often
means also caring for relatives
and care staff. This has been brought about by Swedish national
and political reforms
in the care of older people.61
One perspective on caring in night nursing revealed in this
study relates caring
to an organization that mainly requires RNs’ medical services.
Conversely, caring in
nursing means striving to grasp an overall caring responsibility
by responding to the
vocational and personal demands of being a RN,8 and in
guaranteeing quality, ethical
and competent night-time care for older people.
Critical considerations
This was a small study undertaken in Sweden. The intention was
to obtain a better
under standing of the meaning of caring in municipal night
71. nursing. The interpretation
process was an ongoing dialectical movement between the
whole and parts of the text,
between nearness to and distance from the text, with the
purpose of validating what
the text is revealing. This was completed by all the authors
being involved in different
parts of the analysis. The parallel reading made it possible to
approach the relational
uniqueness that is always there in everyday (night) nursing
practice. Ricoeur33 argues
that there is always more than one way of understanding a text,
but this does not mean
that all interpretations are equal. The results of these analyses
should be judged taking
into account the authors’ pre-understandings. None of the
authors have experience
of municipal night care for older people, however, all three are
experienced RNs and
educators, and have knowledge and interest in caring. To these
authors, the results
represent a most useful and credible understanding of these
RNs’ experiences of the
meaning of caring in night nursing.
There has been emphasis on describing the interpretation
procedure in a way that
provides possibilities for the reader to follow the interpretation
from the raw material
610 C Gustafsson et al.
Nursing Ethics 2009 16 (5)
72. to the comprehensive understanding. Transferring the findings
to other contexts there-
fore presupposes a recontextualization of the results to the
actual context.35,62 Results
obtained using this method may be considered credible if RNs
recognize descriptions
or interpretations comparable with their own.35,62 This allows
results to be transferred
to other comparable situations.
Conclusion and applications
This study was an exploration of caring in nursing by municipal
night RNs that reveals
both ethical dimensions and problems. Although the
organization mainly requires RNs’
medical services, the RNs experience that caring in nursing
means striving to grasp an
overall caring responsibility connected to the RN profession.
This involves striving
to offer quality, ethical and sufficient caring to older people
during the night. This
entails understanding that caring is the ethical foundation of
nursing. In considering
the context, it is important to understand that the care recipients
are older people and
some times their relatives and also care staff, which is
necessary for preparing propitious
conditions for the care of these older people. This indicates the
presence of dimensions
of family nursing.63,64 The findings consequently point to the
necessity to implement
further studies observing municipal night RNs caring for
relatives and care staff in
addition to the elderly people in their care. The results of this
study can be applied to
increase understanding of RNs’ ethical reasoning when having