Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses.

AIMS: To examine the associations between nurse work environment with nurses' silence about patient safety and the mediating effects of professional discrimination experienced by nurses. DESIGN: Multicentre cross-sectional study. METHODS: Between January and April 2019, 607 nurses and nursing assistants from seven hospitals in Greece assessed their clinical environment using the 'Practice Environment Scale of the Nursing Work Index Revised-PES-NWIR', and the silence about patient safety. The 'Experiences of Discrimination Index' was adapted to specifically address experienced discrimination based on the nursing profession. The PROCESS macros for SPSS were used to examine the above associations. FINDINGS: Better nurse practice environment, with the exception of 'staffing and resource adequacy' dimension, was directly associated with less experienced professional discrimination, and directly and indirectly associated with less silence about patient safety, through the mediating role of professional discrimination experienced by nurses. CONCLUSIONS: Silence about patient safety is dependent on the clinical work environment and may be a response of nurses to discrimination in the work context. Both an improvement in the nurse work environment and a decrease in professional discrimination would minimize silence about patient safety. IMPACT: On many occasions, nurses are directly or indirectly discouraged from voicing their concerns about patient safety or are ignored when they do, leading to employee silence and decreasing the standard of care (Alingh et al., BMJ Quality & Safety, 2019, 28, 39; Pope, Journal of Change Management, 2019, 19, 45). Nurses' work-related determinants for silence are not clearly understood in the patient safety context. A favourably evaluated nurse practice environment is associated with less experienced professional discrimination and less silence about patient safety. To minimize silence about patient safety, both the nurse work environment and the experienced professional discrimination should be taken into consideration by nurse and healthcare managers.

Family ties and functional limitation in the elderly: Results from the Survey of Health Ageing and Retirement in Europe (SHARE).

OBJECTIVES: To examine if family ties are strong predictors of functional limitation in older adults in Europe. METHODS: Cross sectional data were used and included 14 European countries from the second wave (w2) of the survey on Health, Ageing, and Retirement in Europe. 13,974 adults aged 50+ (45.2% males and 54.8%females) were included in the study. Functional limitation was assessed using activities of daily living (ADL), instrumental activities of daily living (i-ADL) and mobility sensory index. Family ties were based on a customized model of family structural aspects. Multiple logistic regression analyses were used to examine the risk of functional limitations. RESULTS: Functional limitation was associated with females, age, self-rated health, and an increased number of chronic conditions, disease symptoms and depressive symptoms but not with few family ties. After controlling for potential confounders, respondents with lower family contacts showed higher risk for functional limitation. Southern and Mediterranean countries have both closer family ties and adults with higher functional limitation. CONCLUSION: Functional limitation is associated with biological and demographic factors as well as little contact with family members. Further longitudinal research is required in order to determine the association and the causal relationship between functional limitation and family ties.

Social Capital, Perceived Economic Affluence, and Smoking During Adolescence: A Cross-Sectional Study.

BACKGROUND: Smoking is among the health risk behaviors taken up by many adolescents with lifelong consequences and associations with multiple health risk behaviors. Smoking and smoking initiation in adolescence involves an interaction between micro-, meso-, and macro systems, including neighborhoods and the greater community. OBJECTIVES: To examine the associations of individual social and economic capital with self-reported health, life satisfaction, and smoking behavior in adolescents. METHODS: Using a multistage random sampling of junior high school students (16-18 years old) in Crete, Greece, 703 adolescents (90.2% 16 years old; 55.6% girls, participation rate 84.2%) completed an anonymous questionnaire based on HBSC study and the Youth Social Capital Scale (YSCS) during April-June 2008. Multiple logistic regression models were performed adjusted for potential confounders. RESULTS: Adolescents with high participation in their neighborhoods and communities (higher structural social capital) displayed lower odds for daily smoking; those feeling unsafe (lower cognitive social capital) were at greater odds of daily smoking. Adolescents with less friends and acquaintances had lower odds of having tried tobacco products. Smoking was not related to any economic capital variables (perceived affluence, paternal and maternal employment status). Adolescents with low/medium versus high total social capital were at higher odds for low life satisfaction and fair/bad versus excellent self-rated health. Conclusions/Importance: Social capital theory may provide a better understanding in identifying the social context that is protective or harmful to adolescents' smoking. Public health organizations at all levels need to incorporate social capital theory in their interventions.

Meso level influences on long term condition self-management: stakeholder accounts of commonalities and differences across six European countries.

BACKGROUND: European countries are increasingly adopting systems of self -care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. To date the focus of policy for engendering greater self- management in the population has been focused in the main on the actions and motivations of individuals. Less attention has been paid to how the broader influences relevant to SMS policy and practice such as those related to food production, distribution and consumption and the structural aspects and economics relating to physical exercise and governance of health care delivery systems might be implicated in the populations ability to self- manage. This study aimed to identify key informants operating with knowledge of both policy and practice related to SMS in order to explore how these influences are seen to impact on the self-management support environment for diabetes type 2. METHODS: Ninety semi-structured interviews were conducted with key stakeholder informants in Bulgaria, Spain, Greece, Norway, Netherlands and UK. Interviews were transcribed and analysed using thematic and textual analysis. RESULTS: Stakeholders in the six countries identified a range of influences which shaped diabetes self-management (SM). The infrastructure and culture for supporting self- management practice is viewed as driven by political decision-makers, the socio-economic and policy environment, and the ethos and delivery of chronic illness management in formal health care systems. Three key themes emerged during the analysis of data. These were 1) social environmental influences on diabetes self-management 2) reluctance or inability of policy makers to regulate processes and environments related to chronic illness management 3) the focus of healthcare system governance and gaps in provision of self-management support (SMS). Nuances in the salience and content of these themes between partner countries related to the presence and articulation of dedicated prevention and self- management policies, behavioural interventions in primary care, drug company involvement and the impact of measures resulting from economic crises, and differences between countries with higher versus lower social welfare support and public spending on shaping illness management. CONCLUSIONS: The results suggest reasons for giving increasing prominence to meso level influences as a means of rebalancing and improving the effectiveness of implementing an agenda for SMS. There is a need to acknowledge the greater economic and policy challenging environment operating in some countries which act as a source of inequality between countries in addressing SMS for chronic illness management and impacts on people's capacity to undertake self-care activities.

Dynamics and nature of support in the personal networks of people with type 2 diabetes living in Europe: qualitative analysis of network properties.

BACKGROUND: Living with and self-managing a long-term condition implicates a diversity of networked relationships. This qualitative study examines the personal communities of support of people with type 2 diabetes. METHODS: We conducted 170 biographical interviews in six European countries (Bulgaria, Greece, the Netherlands, Norway, Spain and UK) to explore social support and networks. Analysis was framed with reference to three predetermined social support mechanisms: the negotiation of support enabling engagement with healthy practices, navigation to sources of support and collective efficacy. Each interview was summarized to describe navigation and negotiation of participants' networks and the degree of collective efficacy. RESULTS: Analysis highlighted the similarities and differences between countries and provided insights into capacities of networks to support self-management. The network support mechanisms were identified in all interviews, and losses and gains in networks impacted on diabetes management. There were contextual differences between countries, most notably the impact of financial austerity on network dynamics. Four types of network are suggested: generative, diverse and beneficial to individuals; proxy, network members undertook diabetes management work; avoidant, support not engaged with; and struggling, diabetes management a struggle or not prioritized. CONCLUSIONS: It is possible to differentiate types of network input to living with and managing diabetes. Recognizing the nature of active, generative aspects of networks support is likely to have relevance for self-management support interventions either through encouraging continuing development and maintenance of these contacts or intervening to address struggling networks through introducing the means to connect people to additional sources of support.