Nursing Competence in Norwegian Municipal in-patient Acute Care Professional Accountability, Environment, and Leadership

Background: Changes from the introduction of the Coordination Reform in Norway have induced an increase in the need for highly qualified nursing staff in the primary health care service. Among the most important initiatives of the Coordination Reform in Norway is the municipal in-patient acute care (MipAC) service. All municipalities must provide in-patient acute care for patients requiring 24-hour care or observation. The MipAC is expected to deliver safe quality care and may entail many patient and societal benefits. However, the service establishment and organisation differ per municipality, putting the service quality into question. Older and vulnerable patients constitute the largest group of patients under the MipAC service. Even though the benefits of well-educated and competent nursing staff to care for vulnerable older people are broadly recognised, the requirements for nursing competence are sparsely defined in governmental documents, and knowledge of nursing competence in the services is lacking. Aim: This study explores and describes aspects of nursing competence in the MipAC service. It answers the following question: What is the necessary nursing competence in MipAC, and how is it facilitated, maintained, and enhanced?acceptedVersio

Critical Team Composition Issues for Long-Distance and Long-Duration Space Exploration: A Literature Review, an Operational Assessment, and Recommendations for Practice and Research

Prevailing team effectiveness models suggest that teams are best positioned for success when certain enabling conditions are in place (Hackman, 1987; Hackman, 2012; Mathieu, Maynard, Rapp, & Gilson, 2008; Wageman, Hackman, & Lehman, 2005). Team composition, or the configuration of member attributes, is an enabling structure key to fostering competent teamwork (Hackman, 2002; Wageman et al., 2005). A vast body of research supports the importance of team composition in team design (Bell, 2007). For example, team composition is empirically linked to outcomes such as cooperation (Eby & Dobbins, 1997), social integration (Harrison, Price, Gavin, & Florey, 2002), shared cognition (Fisher, Bell, Dierdorff, & Belohlav, 2012), information sharing (Randall, Resick, & DeChurch, 2011), adaptability (LePine, 2005), and team performance (e.g., Bell, 2007). As such, NASA has identified team composition as a potentially powerful means for mitigating the risk of performance decrements due to inadequate crew cooperation, coordination, communication, and psychosocial adaptation in future space exploration missions. Much of what is known about effective team composition is drawn from research conducted in conventional workplaces (e.g., corporate offices, production plants). Quantitative reviews of the team composition literature (e.g., Bell, 2007; Bell, Villado, Lukasik, Belau, & Briggs, 2011) are based primarily on traditional teams. Less is known about how composition affects teams operating in extreme environments such as those that will be experienced by crews of future space exploration missions. For example, long-distance and long-duration space exploration (LDSE) crews are expected to live and work in isolated and confined environments (ICEs) for up to 30 months. Crews will also experience communication time delays from mission control, which will require crews to work more autonomously (see Appendix A for more detailed information regarding the LDSE context). Given the unique context within which LDSE crews will operate, NASA identified both a gap in knowledge related to the effective composition of autonomous, LDSE crews, and the need to identify psychological and psychosocial factors, measures, and combinations thereof that can be used to compose highly effective crews (Team Gap 8). As an initial step to address Team Gap 8, we conducted a focused literature review and operational assessment related to team composition issues for LDSE. The objectives of our research were to: (1) identify critical team composition issues and their effects on team functioning in LDSE-analogous environments with a focus on key composition factors that will most likely have the strongest influence on team performance and well-being, and 1 Astronaut diary entry in regards to group interaction aboard the ISS (p.22; Stuster, 2010) 2 (2) identify and evaluate methods used to compose teams with a focus on methods used in analogous environments. The remainder of the report includes the following components: (a) literature review methodology, (b) review of team composition theory and research, (c) methods for composing teams, (d) operational assessment results, and (e) recommendations

The impact of rescue work on mental health and private life tasks:How to protect health and effectiveness in private life tasks in a high risk job

This thesis aims to assess the impact of rescue work on the mental health and the functioning levels in the private lives of rescue workers. We aspire to inspire further research and the development of preventive diagnostic tools, which could further strengthen the mental health of rescue workers and improve the effective functioning in their private lives. It presents the theoretical essence of the concept 'life task' and a discussion of four practical studies. Research questions 1) How can we conceptualize the private life functioning of rescue workers, and develop an adequate measure? 2) How does the accumulation of critical incidents and other work characteristics (workload, social support) relate to mental health in rescue workers? 3) How does the accumulation of critical incidents and other work characteristics (workload, social support) relate to private life functioning in rescue workers? 4) By what process do the accumulations of critical incidents and other work characteristics influence private life functioning in rescue workers; more specifically, what is the role of mental health in this process? 5) Can preventive training improve the private life functioning of rescue workers and if so, which rescue workers benefit from such an intervention? Research method Cross-sectional. Most important conclusions 'Life tasks' are defined as the experienced effectiveness in developing one's life and their maintenance as 'pillars of mental health' (Chapter 2). The concept consists of the following elements: social life; maintaining of mental health; household and finance; giving meaning; positivity. The experienced effectiveness of the life tasks concerns the care and the responsibility to maintain these tasks. If they are being well sustained, they will provide a resource of good mental health and well-being. This requires discipline and pro-active behavior. This thesis describes the development of a Life Task Test, which was found to be a reliable and a valid instrument that consists of the following scales: social life, mental health, household and finance, giving meaning, positivity.The first study (Chapter 3) examines the impact of accumulated critical incidents and the workload of 67 rescue workers (police officers and medical emergency drivers). Although health problems do not appear to be affected, the accumulation of critical incidents does lead to an increase in the experienced workload. Social support from managers and colleagues does not appear to have any moderating effect.The second study (Chapter 4) describes the development of a reliable and valid instrument that measures the experienced effectiveness in life tasks. Subjects of this study are police officers, who are absent from work due to their mental health adversities. The following are noteworthy conclusions: the experienced workload is related to an experienced diminished effectiveness in mental health status and positivity levels; the experienced lack of support from the managers and colleagues is related to an experienced diminished effectiveness in mental health, giving meaning and positivity; Ruminating about work is related to a diminished effectiveness in mental health, giving meaning and positivity. Police officers, who report experiencing more health complaints, feel less effective in positivity and in maintaining their mental health. Personal negativity and somatisation is related to an experienced diminished effectiveness in all life tasks. An exception is negativism. It is unrelated to an experienced diminished effectiveness in the social life.The third study (Chapter 5) examines the mediating effect of mental health on the effectiveness in life tasks. Predictors are critical incidents and workload. This study was performed among 166 police officers, who are absent from work due to mental health problems. Results confirm the process of erosion. Mental health is undermined by an accumulation of critical incidents and it leads to a deterioration in the functioning levels in the life tasks.The fourth study (Chapter 6) inspects the effect of a preventive training on the mental condition in a highly demanding professional environment, by means of self-management tools. The research group consisted of 67 rescue workers (police officers and ambulance personnel), who participated in two sessions. No significant improvement could be established. A possible explanation could be that this group consisted of more experienced rescue workers, who may be less susceptible to such training. Additionally, it is possible that a preventive training leads to an increased awareness of healthy stress signals, which could result in lower scores in the experienced levels of improvement. Differential analyses show that the higher the score on critical incidents is, the lower the score will be on giving meaning and positivity. Age was a negative predictor for the life task household and finance and positivity. Most important recommendations Practical recommendations stress the importance of incorporating preventive tools in the daily routines in the professional and the private life of the rescue workers (Chapter 7). These may comprise of recovery time, sources of energy, appreciation, acquiring more control and influence in work (e.g. work schedules), improving work organization, giving meaning and maintaining positivity (professionally and personally). In practical terms this implies the monitoring of accumulation and arrangement of recovery time (to be initiated by management and/or the rescue worker); setting limits to time served in the front line (3 to 5 years at most for the heaviest duties); limiting irregular work shifts (no more night shifts over the age of 55); discussing with colleagues what one did correctly and what went well. It is recommended that maintaining self-care and self-management are incorporated in the professional training courses, at a time when the professional and private environment is secure and safe. One of the great pitfalls of this type of profession is the fact that actions and behaviors are dictated by dangerous circumstances and then they are transferred to the private life.In treating psychological problems, it is recommended to integrate the reinforcement of life tasks in the course of treatment. Improving the effectiveness in life tasks contributes to recovery. Additionally, while evaluating a regular list of complaints, one should take the 'underscore' response into consideration, due to the tendency of a strong self-representation among this population. The Life Task Test can transcend this issue and provide more insight into the actual functioning levels of the rescue worker.Prior to trauma treatment, it is recommended to determine the level of erosion and functioning in life tasks by means of a diagnostic interview and the Life Task Test, since intensive trauma treatment may lead to even more serious disturbance of an already fragile balance

The effect of training on the promotion of emotional intelligence and its indirect role in reducing job stress in the emergency department

Objective: The present study aimed at evaluating the role of training in improving emotional intelligence (EI) skills and assessing its indirect effect on reducing job stress in emergency medicine residents (EMRs). Methods: In the present study, 20 EMRs were trained for EI skills while 22 EMRs received no training. Then, all participants’ EI level and job stress were assessed and compared before and after the intervention using the Bar-On Emotional Quotient Inventory(EQ-I) and the Osipow job stress questionnaire, respectively. Results: The results of the present study revealed that the EI level in the training group with a mean score of 338.27 ± 27.57 was significantly higher than the control group with a mean score of 320.50 ± 28.50 after training intervention (P = 0.043). In addition, job stress in the training group with a mean score of 170.82 ± 16.11 was significantly lower than the control group with a mean score of 183.30 ± 22.21 (P=0.045). Moreover, in the training group, the relationship between EI and job stress was inverse and significant (r = -0.746, P<0.001), but in the control group it was non-significant (r = 0.017, P=0.938). Conclusion: According to the results of the present study, training for EI skills can play a significant role in improving EI and reducing stress in EMRs

Patient Safety As An Interactional Achievement: Conversational Analysis In The Trauma Center Of An Inner City Hospital

In this dissertation, I apply the methodology of Conversational Analysis to highlight the informal communication of an emergency room work group with the objective of discovering recurrent patterns of interaction and the inherent relational work necessary to accomplish the safe medical care of patients in a Trauma Code on a level of safety comparative to that of ultra-safe systems as described in the literature of High Reliability Organizations. The significance of relational elements of interaction on emerging social order is highlighted in processes of attunement, or the diminishing of difference of status in the use of mitigated speech and the co-construction of narrative. The use of mitigated speech and narrative serve as conversational moves of consequence, by which participants seek cooperation, coordination, and collaborate in face-to-face interaction, in a mutually constructed course of action; that is, in providing safe medical care in a highly complex and high risk environment

The Impact Of Telemedicine On Teamwork And Communication, Workload, And Clinical Performance: A Randomized Controlled Trial

Telemedicine can be used to provide specialty care to critically ill patients in rural and community hospital settings. However, the effects of this technology on quality of care are unclear. The objectives of this study were to evaluate the impact of a telepresent team leader on teamwork and communication, workload, and quality of care during a simulated pediatric resuscitation, and to explore provider perspectives on the use of telemedicine during resuscitations. Twenty standardized teams (lead MD + bedside MD + two confederate clinical team members) were randomized to have a telepresent or an in-person leader. Telepresent leaders were connected via videoconference from a remote location and displayed on a screen at the bedside. All teams participated in a standardized, pre-programmed 20-minute simulated resuscitation with a scripted parent actor present. Simulations were video recorded and scored on teamwork and communication as well as clinical performance metrics using the validated STAT instrument. After each case, team members completed demographic, workload (NASA rTLX), and teamwork and communication (TeamMonitor) surveys. Post-simulation debriefings were scripted to collect qualitative data from participants regarding utility, effectiveness, and acceptability of telepresence. There was no difference in STAT teamwork and communication scores (73 v 66; p=0.118), TeamMonitor scores (91 v 94; p=0.251), or teamwork and communication global rating scores (91 v 77; p=0.143). There was no difference in rTLX workload scores compared between team leaders (51 v 55; p=0.983) or between junior team members (44 v 59; p=0.123). Similarly, no difference was found in STAT clinical performance scores (72 v 64; p=0.168) or in time-to-defibrillation (238 sec v 253 sec; p=0.762). Participating providers shared perspectives on the use of telepresence during resuscitation and expressed varying levels of comfort using the modality. Providers also highlighted strategies for the effective use of telepresence in the acute care setting, including enhanced verbal communication, role delineation, and mutual trust in clinical acumen of each provider involved. Telepresence did not significantly impact teamwork and communication, workload, or clinical performance. Participating providers shared perspectives on the impacts of telepresence as well as strategies for effective use of telepresence in the acute care setting. Together, these data may inform future implementation of telepresence technology in emergency settings

Testing the relationship between staff satisfaction and patient satisfaction in the Palestinian health care service as a way of exploring the management culture

Available from British Library Document Supply Centre- DSC:DXN058268 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

The Antecedents And Consequences Of Work-Family Conflict Among Doctors In Public Hospitals In Peninsular Malaysia

Kajian ini menghasilkan dan menguji satu model konflik kerja-keluarga kalangan doktor melalui tiga cara. This study developed and tested a model of work-family conflict (WFC) among dotors in three ways