An exploration of the link between residents' demands and caregivers' well-being: Evidence from the long-term healthcare industry.

This study examines the extent to which important personal characteristics of nursing home residents affect the well-being of caregivers, as reflected in their levels of work-related positive and negative affect. To do this, we applied the Job Demands-Resources model to the analysis of caregivers' work-related well-being by focusing on residents' residual cognitive capacity and their perceived adequacy of resources. A multiple regression analysis was carried out based on combined data from a sample of 1080 caregivers and 290 residents from 13 nursing homes in Italy. Predictors of caregivers' positive and negative well-being included job characteristics such as workload and social support. As expected, residents' perceived adequacy of resources was positively related to caregivers' well-being positive affect. Unexpectedly, residents' residual cognitive capacity was associated with higher rather than lower levels of caregivers' well-being negative affect. The quality of the interaction between residents and caregivers in nursing homes is contingent on their respective expectations and capabilities, and reciprocal perceptions of the outputs exchanged.

'Poppets and parcels': the links between staff experience of work and acutely ill older peoples' experience of hospital care.

BACKGROUND: Few empirical studies have directly examined the relationship between staff experiences of providing healthcare and patient experience. Present concerns over the care of older people in UK acute hospitals - and the reported attitudes of staff in such settings - highlight an important area of study. AIMS AND OBJECTIVES. To examine the links between staff experience of work and patient experience of care in a 'Medicine for Older People' (MfOP) service in England. METHODS: A mixed methods case study undertaken over 8 months incorporating a 149-item staff survey (66/192 - 34% response rate), a 48-item patient survey (26/111 - 23%), 18 staff interviews, 18 patient and carer interviews and 41 hours of non-participant observation. RESULTS: Variation in patient experience is significantly influenced by staff work experiences. A high-demand/low-control work environment, poor staffing, ward leadership and co-worker relationships can each add to the inherent difficulties staff face when caring for acutely ill older people. Staff seek to alleviate the impact of such difficulties by finding personal satisfaction from caring for 'the poppets'; those patients they enjoy caring for and for whom they feel able to 'make a difference'. Other patients - noting dehumanising aspects of their care - felt like 'parcels'. Patients are aware of being seen by staff as 'difficult' or 'demanding' and seek to manage their relationships with nursing staff accordingly. CONCLUSIONS: The work experiences of staff in a MfOP service impacted directly on patient care experience. Poor ward and patient care climates often lead staff to seek job satisfaction through caring for 'poppets', leaving less favoured - and often more complex patients - to receive less personalised care. Implications for practice. Investment in staff well-being and ward climate is essential for the consistent delivery of high-quality care for older people in acute settings.

Impact of the role of nurse, midwife and health visitor consultant.

AIM: This paper describes the findings from one aspect of an evaluation study of the role of the nurse, midwife and health visitor consultant and the consultants' perceived impact of their role on services and patient care. BACKGROUND: The nurse, midwife and health visitor consultant role was established in 2000 in England to improve patient care, strengthen leadership and provide a clinical career opportunity for nurses, midwives and health visitors. An evaluative study was commissioned to report on the role 4 years after the new consultant posts were first established. METHOD: A multimethod evaluation was undertaken in 2002-2003 combining focus groups, telephone interviews and a comprehensive questionnaire survey of all the consultants in England. Four hundred and nineteen consultants responded to the questionnaire, 22 volunteered for the focus groups and 32 participated in the interviews. RESULTS: Nearly half (44%) the consultants who responded to the survey reported having a substantial impact on their service and 55% reported having some positive impact. High reported impact increased to 71% for those who had been in post for 2 years or longer. Consultants felt that they had been most successful in providing better support to staff, but only 10% said that they had a major impact on reducing unnecessary expenditure within the service. Factors associated with high levels of reported impact included engagement in a wide range of activities, perceived competence in the role and strong medical support. Those reporting most impact also reported the greatest dissatisfaction with salary. CONCLUSION: As consultants become more established in their posts, they are able to identify improvements in practice, service reconfiguration and educational advantages for staff. Our findings suggest that the true influence of these posts will become clearer over time as the impact of consultants on long-term organizational change becomes more apparent.