The short form of the Workplace Affective Commitment Multidimensional Questionnaire (WACMQ-S): A bifactor-ESEM approach among healthcare professionals

Although it has long been recognized that employees' workplace affective commitment can be directed at a variety of foci, theory and research on this multifocal perspective remain underdeveloped, possibly due to the lack of a short, yet comprehensive measure. The purpose of the present study was to assess the psychometric properties of a newly developed short (24-item) version of the Workplace Affective Commitment Multidimensional Questionnaire (WACMQ-S), covering affective commitment directed at the organization, supervisor, coworkers, customers, tasks, profession, work, and career. Using two independent samples of English - (N = 676, including 648 females) and French - (N = 733, including 593 females) speaking healthcare professionals and the newly developed bifactor-ESEM framework, the present study supported the factor validity, composite reliability, test-retest reliability, linguistic invariance, and criterion-related validity (in relation to turnover intentions, in-role performance, and organizational citizenship behaviors) of the WACMQ-S ratings. The results also demonstrated the superiority of a bifactor-ESEM representation of WACMQ-S ratings, confirming the importance of taking into account employees' global levels of commitment to their work life. Finally, the results also proved to be fully generalizable to subsamples of hospital and community healthcare professionals, as well as of nurses and beneficiary attendants

The Toronto prehospital hypertonic resuscitation-head injury and multi organ dysfunction trial (TOPHR HIT) - Methods and data collection tools

<p>Abstract</p> <p>Background</p> <p>Clinical trials evaluating the use of hypertonic saline in the treatment of hypovolemia and head trauma suggest no survival superiority over normal saline; however subgroup analyses suggest there may be a reduction in the inflammatory response and multiorgan failure which may lead to better survival and enhanced neurocognitive function. We describe a feasibility study of randomizing head injured patients to hypertonic saline and dextran vs. normal saline administration in the out of hospital setting.</p> <p>Methods/Design</p> <p>This feasibility study employs a randomized, placebo-controlled design evaluating normal saline compared with a single dose of 250 ml of 7.5% hypertonic saline in 6% dextran 70 in the management of traumatic brain injuries. The primary feasibility endpoints of the trial were: 1) baseline survival rates for the treatment and control group to aid in the design of a definitive multicentre trial, 2) randomization compliance rate, 3) ease of protocol implementation in the out-of-hospital setting, and 4) adverse event rate of HSD infusion.</p> <p>The secondary objectives include measuring the effect of HSD in modulating the immuno-inflammatory response to severe head injury and its effect on modulating the release of neuro-biomarkers into serum; evaluating the role of serum neuro-biomarkers in predicting patient outcome and clinical response to HSD intervention; evaluating effects of HSD on brain atrophy post-injury and neurocognitive and neuropsychological outcomes.</p> <p>Discussion</p> <p>We anticipate three aspects of the trial will present challenges to trial success; ethical demands associated with a waiver of consent trial, challenging follow up and comprehensive accurate timely data collection of patient identifiers and clinical or laboratory values. In addition all the data collection tools had to be derived de novo as none existed in the literature.</p> <p>Trial registration number</p> <p>NCT00878631</p

Insights into Nurses’ Work: Exploring Relationships among Work Attitudes Work-related Behaviours

Work motivation has been associated with work productivity. In health care, low motivation levels are associated with low productivity and linked to poor performance, decreased patient safety, and overall poor quality care. Hence the importance, ascribed in the literature, to clearly identifying the relationships between and among factors associated with work motivation, including work attitudes, and behaviours linked to work performance such as extra-role behaviours. Despite their importance to performance in health care, these relationships are understudied and poorly understood. The purpose of this study is to better understand work attitudes and their relationships to one another and to extra-role behaviours amongst nurses working in hospitals, the community, and long-term care settings in Ontario. This study comprises two stages: first, a scoping review focused on identifying individual-, unit-level, and organization-level characteristics that influence work motivation in health service organizations. The findings from the scoping review, augmented by a more in-depth review of the literature, aided in the development of a conceptual framework that guided the second stage of the study, to examine relationships amongst a specific set of nurses’ work attitudes - including perceptions of organizational justice, perceived organizational support, and affective commitment - and extra-role behaviours – specifically, organizational citizenship behaviours - in Ontario health care settings. In the second stage of the study, a survey was developed and administered to frontline nurses actively working in hospitals, the community, and long-term care settings in Ontario. Relationships amongst the constructs of interest were examined using structural equation modeling and path analysis. Examining the relationships of these concepts in a single model is novel, and offers insights regarding their complexity. The analyses further suggest that prior studies may be under-nuanced, and approaches to conceptualizing the concepts of perceived organizational justice and affective commitment in particular may have led to erroneous conclusions regarding their associations with perceived organizational support and organizational citizenship behaviours. This study further addresses four significant gaps previously identified in the work motivation and work behaviour literature: (1) how affective commitment relates to behavioural efforts, specifically organizational citizenship behaviours; (2) utilization of reliable and validated instruments to study work motivation; (3) use of a sufficiently large sample to have empirical support for generalizability; and (4) examination of these phenomena, among nurses, across diverse health care settings.Ph.D

Prehospital evaluation and economic analysis of different coronary syndrome treatment strategies - PREDICT - Rationale, Development and Implementation

Abstract Background A standard of prehospital care for patients presenting with ST-segment elevation myocardial infarction (STEMI) includes prehospital 12-lead and advance Emergency Department notification or prehospital bypass to percutaneous coronary intervention centres. Implementation of either care strategies is variable across communities and neither may exist in some communities. The main objective is to compare prehospital care strategies for time to treatment and survival outcomes as well as cost effectiveness. Methods/Design PREDICT is a multicentre, prospective population-based cohort study of all chest pain patients 18 years or older presenting within 30 mins to 6 hours of symptom onset and treated with nitroglycerin, transported by paramedics in a number of different urban and rural regions in Ontario. The primary objective of this study is to compare the proportion of study subjects who receive reperfusion within the target door-to-reperfusion times in subjects obtained after four prehospital strategies: 12-lead ECG and advance emergency department (ED) notification or 3-lead ECG monitoring and alert to dispatch prior to hospital arrival; either with or without the opportunity to bypass to a PCI centre. Discussion We anticipate four challenges to successful study implementation and have developed strategies for each: 1) diversity in the interpretation of the ethical and privacy issues across 47 research ethics boards/commiittees covering 71 hospitals, 2) remote oversight of data guardian abstraction, 3) timeliness of implementation, and 4) potential interference in the study by concurrent technological advances. Research ethics approvals from academic centres were obtained initially and submitted to non academic centre applications. Data guardians were trained by a single investigator and data entry is informed by a detailed data dictionary including variable definitions and abstraction instrucations and subjected to error and logic checks. Quality oversight provided by a single investigator. The window of the trial in each community has been confirmed with the basehospital medical director to correspond to the planned technological advances of the system of care. We hope this comparative analysis across treatment strategies for clinical outcomes and cost will provide sufficient evidence to implement the superior strategy across all communities and improve outcomes for all STEMI patients. Trial registration ClinicalTrials.gov: NCT00747656</p

Prehospital evaluation and economic analysis of different coronary syndrome treatment strategies - PREDICT - Rationale, Development and Implementation

Abstract Background A standard of prehospital care for patients presenting with ST-segment elevation myocardial infarction (STEMI) includes prehospital 12-lead and advance Emergency Department notification or prehospital bypass to percutaneous coronary intervention centres. Implementation of either care strategies is variable across communities and neither may exist in some communities. The main objective is to compare prehospital care strategies for time to treatment and survival outcomes as well as cost effectiveness. Methods/Design PREDICT is a multicentre, prospective population-based cohort study of all chest pain patients 18 years or older presenting within 30 mins to 6 hours of symptom onset and treated with nitroglycerin, transported by paramedics in a number of different urban and rural regions in Ontario. The primary objective of this study is to compare the proportion of study subjects who receive reperfusion within the target door-to-reperfusion times in subjects obtained after four prehospital strategies: 12-lead ECG and advance emergency department (ED) notification or 3-lead ECG monitoring and alert to dispatch prior to hospital arrival; either with or without the opportunity to bypass to a PCI centre. Discussion We anticipate four challenges to successful study implementation and have developed strategies for each: 1) diversity in the interpretation of the ethical and privacy issues across 47 research ethics boards/commiittees covering 71 hospitals, 2) remote oversight of data guardian abstraction, 3) timeliness of implementation, and 4) potential interference in the study by concurrent technological advances. Research ethics approvals from academic centres were obtained initially and submitted to non academic centre applications. Data guardians were trained by a single investigator and data entry is informed by a detailed data dictionary including variable definitions and abstraction instrucations and subjected to error and logic checks. Quality oversight provided by a single investigator. The window of the trial in each community has been confirmed with the basehospital medical director to correspond to the planned technological advances of the system of care. We hope this comparative analysis across treatment strategies for clinical outcomes and cost will provide sufficient evidence to implement the superior strategy across all communities and improve outcomes for all STEMI patients. Trial registration ClinicalTrials.gov: NCT0074765