Job innovation for direct caregivers in the care of persons with mental retardation. A system of personal caregiving.

Professionals in different branches of the health care sector increasingly advocate a more flexible, individually-tailored type of care. To fit in with this trend, the Job Innovation Model was developed in The Netherlands. This model involves the systematic introduction of a system of personal caregiving. The purpose of the present study, using a pre-test-post-test quasi-experimental design, was to evaluate the effects of the implementation of the Job Innovation Model on the work and work perception of direct caregivers in the care of persons with mental retardation. Caregivers in the experimental group were found to have adopted the principles of the Job Innovation Model to a greater extent than their colleagues in the control group, and as a result, the experimental group started to work more methodically and perceived greater clarity in their work. In addition, a trend was observed towards greater job satisfaction among caregivers as a result of the introduction of the new model. No changes were found concerning burnout.

Nurses' well-being in a primary nursing care setting in The Netherlands.

A study was conducted in a Dutch hospital to evaluate the effects of the implementation of a Dutch form of Primary Nursing on nurses' well-being in the work situation. The variables used as indicators of well-being at work were job satisfaction, experienced job significance, health complaints and absenteeism. The study included three measuring periods: one pre-intervention (t1) and two post-intervention periods (t2, 8 months after t1, and t3, 14 months after t1). Primary Nursing was implemented in group 1 (consisting of two nursing units) after t1. At this time no changes were introduced into group 2 (three nursing units) but after t2. Primary Nursing was also implemented in group 2. The research variables were measured by means of questionnaires. The results of the study indicate that most of the expected effects of Primary Nursing did not occur. Some methodological and practical explanations for this outcome are given.

[Resident-oriented nursing care in nursing homes. Testing of a measuring tool]. / Bewonergericht verplegen in het verpleeghuis. Het testen van een meetinstrument.

The findings of an investigation of a patient oriented nursing system in nursing homes are reported in this article. The direct translation of the Dutch word for this type of nursing system is 'Integrated Nursing'. Central to this study are the two premises of Integrated Nursing, namely patient allocation and working in a systemical manner, which is similar to the nursing process. The aim of this study was to determine the validity and reliability of an instrument which was developed to measure the degree of Integrated Nursing in nursing homes. For this purpose, an existing instrument designed for use in general hospitals was modified for use with nursing homes. The modified instrument was tested in two nursing homes: one with a task-oriented nursing system and the other with Integrated Nursing. The instrument was used in the form of both questions and observations. It was concluded that the modified instrument which consists of a Patient Allocation SubScale and a Nursing Process SubScale was reliable and valid.

Primary nursing and quality of care: a Dutch study.

In an 850-bed Dutch hospital a study was carried out to compare the quality-of-care scores of a Primary Nursing group and a lagged experimental group. Process as well as outcome aspects of quality of care were investigated. The study consisted of three measuring moments: one pre-intervention at t1, March 1992, and two post-intervention moments at t2, November 1992 and t3, May 1993. The intervention was formed by the implementation of Primary Nursing in two experimental units after t1; this is the experimental group. After t2, Primary Nursing was also implemented in the three control units; this is the lagged experimental group. The process aspects of quality of care were covered by three dimensions: coordination of care, instrumental aspects of care and expressive aspects of care. The outcome aspects of quality of care were measured by evaluating four patient variables: self-care, initiative, patient stress and patient satisfaction. ANOVAs were used to test for significant differences between the experimental and lagged experimental group. The only significant difference in favour of the Primary Nursing group was found on the variable instrumental aspects of care. On the other variables no expected changes were observed. Finally, the implications of the findings are discussed.

A Dutch study of the effects of primary nursing on job characteristics and organizational processes.

In an 850-bed Dutch hospital a study was carried out to evaluate the effects of the implementation of a Dutch form of primary nursing on five job characteristics (viz. autonomy, responsibility, feedback/clarity, complexity/difficulty and job demands) and on the communication and power processes in the organization of the nursing unit. The study consisted of three measuring moments: one pre-intervention (t1, March 1992) and two post-intervention moments (t2, November 1992 & t3, May 1993). Primary nursing was introduced in the two experimental units (the experimental group) after t1. No changes were made to the control group. After t2, this quasi-experimental design changed, because primary nursing was also implemented in the three original control units (the control group) after this moment. The research variables were measured by means of questionnaires. No significant effects were found for the five job characteristics. Only the improvement in the communication with the team head and the decrease in the influence of physicians on patient care in the experimental group and the improved communication with physicians in the control group were in line with expectations. Changes in the amount of influence of different groups on patient care were inconsistent with what had been expected: according to the nurses the influence of the nursing management increased, whereas the influence of the nurses decreased and the influence of the patients did not change. In other words, the shift of power was not in the expected direction.

[Correlations of the quality of nursing care. The relations between the quality of nursing care on the one side and stress experience, patient satisfaction and the nurse's satisfaction on the other side]. / Correlaten van de kwaliteit van de verpleegkundige zorg. De relatie tussen de kwaliteit van de verpleegkundige zorgverlening enerzijds en de stressbeleving, tevredenheid van patiënten en tevredenheid van verpleegkundigen anderzijds.

For different reasons interest for the subject 'quality of care' has increased the last couple of years. One of those reasons is a greater emancipation of the patient, who, just like the insurers, will ask for quality guarantees in the future healthcare system. In this context the relation between the quality of the nursing care (process-variable of the quality of care) and perceived stress and satisfaction of patients and the satisfaction of nurses with their work (outcome-variables) has been investigated. In this investigation a positive relationship has been found between the coordination of care (a dimension of the nursing care quality) and the stress experienced by patients. Also a positive relationship between two dimensions of the nursing care quality (the instrumental and expressive dimensions) and the satisfaction of patients has been found. Finally it is indicated that a negative relationship exists between the instrumental-technical dimension and the satisfaction of nurses.

[Social isolation in the psychiatric department]. / Sociaal isolement in de psychiatrie.

In this article account is given of a validation study, according to the nursing diagnosis 'social isolation'. The label, definition and cluster of defining characteristics according to cluster of defining characteristics according to Townsend (1990) are the starting point, the related factors are left out of consideration. The validation mentioned above was carried out in accordance with the Delphi-method, that consisted of three Delphi rounds. A panel of experts was asked particularly to compile defining characteristics that are relevant for 'social isolation' and to indicate the critical defining characteristics. This procedure generated a cluster of seven defining characteristics for 'social isolation' of which the content validity turned out to be considerably increased with regard to the cluster formulated by Townsend. The distinction between critical defining characteristics and supporting defining characteristics was not clarified by this study.

Working in an intensive or non-intensive care unit: does it make any difference?

OBJECTIVE: To compare intensive care unit and non-intensive care unit nurses regarding work situation characteristics (e.g., work pressure), reaction variables (e.g., job satisfaction), and individual and psychosocial characteristics (e.g., need for autonomy) to explore whether it is more stressful to work on an intensive care unit than on a non-intensive care unit. DESIGN: Descriptive, correlational study. SETTING: Sixteen randomly selected general hospitals in The Netherlands. SAMPLE: 561 intensive care unit and non-intensive care unit nurses from 36 nursing units. MEASUREMENTS: Subjects completed a survey questionnaire with items derived from the Job Diagnostic Survey, the Leader Behavior Questionnaire, the Organizational Stress Questionnaire, and the Utrecht Coping Questionnaire. MAIN OUTCOME MEASURES: The outcome measures were work-related variables including work pressure, autonomy, feedback and clarity, job satisfaction, experienced job significance, health complaints, absence frequency, social support, need for autonomy, and coping strategies. MAIN RESULTS: The results of the study showed that nurses who work in intensive care units had more positive scores than nurses who work in non-intensive care units. Thus the assumptions that intensive care units present more stressful work situations and that intensive care unit nurses show more negative reactions to their work were not supported in this study. CONCLUSION: The results indicate non-intensive care unit nurses may have a greater need for interventions in the work situation.

[Tasks of caregivers in a nursing home. A study of tasks and reactions of caregivers]. / Taken van verzorgenden in een verpleeghuis. Een onderzoek naar taken en reacties van verzorgenden.

This paper describes a study on the task perceptions of enrolled nurses in a nursing home and the relationships between task perceptions and reactions such as burnout, job satisfaction, experienced job significance and absenteeism (Harmsen, 1991). In our study a comparison is made on the one hand between the task perceptions of three different functions in the nursing home, namely the unit heads, the graduated and the student nurses, and on the other hand between the task perceptions of enrolled nurses working on two types of wards, namely somatic and psycho-geriatric wards. Concerning the relationships between task perceptions and reactions, the results of our study show that activities regarding the 'nursing record', the 'nursing report', the 'stimulation of self-care' and 'social contact' usually have a positive relationship with the experienced job significance of enrolled nurses. On the contrary, activities concerning daily care are evaluated negative. Finally, tasks in the area of 'instrumental activities', 'caring for the dying' and 'caring for the privacy of the client' appear to have positive as well as negative effects.

Leadership in the nursing unit: relationships with nurses' well-being.

The head nurse occupies an important position in the nursing unit. Concerning leadership style, a distinction is traditionally made between consideration and initiating structure. Sometimes a third style is distinguished as well, namely 'production-orientated' leadership. In a study of 561 nurses from 16 general hospitals in The Netherlands, the influence of two leadership styles upon the reactions of nurses (job satisfaction, experienced meaningfulness, health complaints and absenteeism) to their work situations was examined, namely the styles of social (i.e. consideration) and instrumental leadership (a combination of the styles initiating structure and production-orientated). The separate effects of the two styles were studied, as well as the connection between combinations of leadership styles and reactions. The results indicate that social leadership contributes positively to nurses' reactions to their job. Instrumental leadership, on the other hand, leads to health complaints. From the analyses of combinations of leadership styles it appears that nurses are most satisfied if the head nurse pays much attention to both dimensions of leadership. For health complaints, a tendency in this direction is also found. Finally, it becomes clear that nurses with a great need for autonomy prefer a different type of leadership from nurses with little need for autonomy.

Nurses' work satisfaction and feelings of health and stress in three psychiatric departments.

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in three psychiatric departments differing in type of work. Subjects were 65 nurses. Questionnaires and interviews were used. From the results it appears that the admissions department receives relatively high scores on the work satisfaction variables. The short-stay department especially scores relatively negative on both the work satisfaction and health and stress variables. These results are explained in terms of the different work situations, stressing the differences between a dynamic psychiatric environment and a work situation where aims and expectations are not met.