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      Health and intention to leave the profession of nursing - which individual, social and organisational resources buffer the impact of quantitative demands? A cross-sectional study

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          Abstract

          Background

          The aim of this study was to analyse the buffering effect of individual, social and organisational resources on health and intention to leave the profession in the context of burden due to quantitative job demands.

          Methods

          In 2017, a cross-sectional survey was carried out anonymously among nurses in palliative care in Germany. One thousand three hundred sixteen nurses responded to the questionnaire (response rate 38.7%), which contained, amongst others, questions from the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ). Moderator analyses were conducted to investigate the buffering effect of different resources on health (‘self-rated health’ and ‘burnout’) and ‘intention to leave’ in the context of quantitative demands.

          Results

          ‘Self-rated health’ was significantly buffered by the resources ‘recognition through salary’ ( p = 0.001) and ‘good working team’ ( p = 0.004). Additionally, buffering effects of the resources ‘workplace commitment’ and ‘good working team’ on ‘burnout’ ( p = 0.001 and p = 0.006, respectively) as well as of the resources ‘degree of freedom’, ‘meeting relatives after death of patients’, ‘recognition from supervisor’ and ‘possibilities for development’ on ‘intention to leave’ ( p = 0.014, p = 0.012, p = 0.007 and p = 0.036, respectively) were observed.

          Conclusions

          The results of our study can be used to develop and implement job (re) design interventions with the goal of reducing the risk of burnout and enhancing job satisfaction among nurses in palliative care. This includes for example adequate payment, communication training and team activities or team events to strengthen the team as well as the implementation of some rituals (such as meeting relatives after the death of patients). As our study was exploratory, the results should be confirmed in further studies.

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          Most cited references44

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          Confidence interval or p-value?: part 4 of a series on evaluation of scientific publications.

          An understanding of p-values and confidence intervals is necessary for the evaluation of scientific articles. This article will inform the reader of the meaning and interpretation of these two statistical concepts. The uses of these two statistical concepts and the differences between them are discussed on the basis of a selective literature search concerning the methods employed in scientific articles. P-values in scientific studies are used to determine whether a null hypothesis formulated before the performance of the study is to be accepted or rejected. In exploratory studies, p-values enable the recognition of any statistically noteworthy findings. Confidence intervals provide information about a range in which the true value lies with a certain degree of probability, as well as about the direction and strength of the demonstrated effect. This enables conclusions to be drawn about the statistical plausibility and clinical relevance of the study findings. It is often useful for both statistical measures to be reported in scientific articles, because they provide complementary types of information.
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            Measuring psychological stress and strain at work - Evaluation of the COPSOQ Questionnaire in Germany

            The undisputed increase of the relevance of mental work load is confronted with a lack of qualified or at least well documented measuring instruments covering all important aspects. The COPSOQ (Copenhagen Psychosocial Questionnaire), a comprehensive instrument for the assessment of psychosocial factors at work, was tested in a partly modified version in a large German sample (N = 2561 employees). The aims of the study were the detailed investigation of the psychometric measurement properties, and based on these results, the development of an abbreviated version of the instrument. The analysis of objectivity, acceptance, practicability, sensitivity and content validity of the questionnaire as a whole did not show any problematic results – with some limitations regarding the length of the questionnaire. The assessment of the reliability, generalisability, construct validity, criterion validity and diagnostic power of the single scales showed medium to good measuring qualities for the majority of the scales (i.e. Cronbach’s alpha mostly >0.7). In addition, the psychometric properties were very similar to those in the Danish COPSOQ-study. Considering all aspects of the measurement quality, a shortened version of the instrument was created. It attempts to combine measuring qualities as high as possible with a number of questions as low as possible. The German COPSOQ questionnaire is a free screening-instrument for the recording of psychosocial work load and strain for all enterprises and organisations interested. The next step is the construction of a "job exposure matrix" for psychosocial factors at work, that means a central database with work load profiles and reference values for as many occupational groups as possible.
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              The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey.

              To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community. Cross-sectional survey. Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N=1201) in two independent hospitals and one hospital group with six hospitals in Belgium. Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively. The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                elidiehl@uni-mainz.de
                Journal
                BMC Palliat Care
                BMC Palliat Care
                BMC Palliative Care
                BioMed Central (London )
                1472-684X
                17 June 2020
                17 June 2020
                2020
                : 19
                : 83
                Affiliations
                [1 ]GRID grid.410607.4, Institute of Occupational, Social and Environmental Medicine, , University Medical Center of the Johannes Gutenberg University Mainz, ; Obere Zahlbacher Str, 67 55131 Mainz, Germany
                [2 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Health Services Research in Dermatology and Nursing (IVDP), , University Medical Centre Hamburg-Eppendorf, ; Hamburg, Germany
                [3 ]GRID grid.491653.c, ISNI 0000 0001 0719 9225, Department for Occupational Medicine, Hazardous Substances and Health Science, , Institution for Accident Insurance and Prevention in the Health and Welfare Services (BGW), ; Hamburg, Germany
                [4 ]GRID grid.432860.b, ISNI 0000 0001 2220 0888, Federal Institute for Occupational Safety and Health (BAuA), ; Berlin, Germany
                Author information
                http://orcid.org/0000-0002-4832-1992
                Article
                589
                10.1186/s12904-020-00589-y
                7298824
                32552671
                b8279cce-a02f-42fc-b171-0b0a876d7848
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 6 February 2020
                : 8 June 2020
                Funding
                Funded by: Institution for Accident Insurance and Prevention in the Health and Welfare Services - Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW)
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Anesthesiology & Pain management
                nurses,palliative care,stress,strain,burnout,moderator analyse,prevention
                Anesthesiology & Pain management
                nurses, palliative care, stress, strain, burnout, moderator analyse, prevention

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