Discussion: Health Services Research Paper

Discussion: Health Services Research Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Health Services Research Paper For this activity, you will appraise and summarize a quantitative study located for the PICOT and Literature Search assignment and approved by your instructor to determine its potential usefulness to inform nursing practice. As part of this analysis, you need to determine the rigor of the investigation and appraise credibility. You can do this by answering some key questions about the integrity with which they collected and analyzed data and employed techniques to reduce bias. Discussion: Health Services Research Paper I attached my PICOT question with my article ( Explaining burnout and the intention to leave the profession among health professionals ) and the appraisal tool with all the instructions that’s needed to finish this assignment. I attached a sample article with the sample completed synopsis which can help you to know what is needed for this assignment. my_picot_question.docx my_article.pdf.pdf quantitative_appraisal_tool_and_synopsis_instructions_and_grading_rubric.docx sample_completed_synopsis.docx sample_article__1_.pdf sample_article__1_.pdf sample_completed_synopsis.docx sample_completed_synopsis_for_the_sample_article.docx Foreground question: In nurses, how does heavy workload compared with the standard workload, effects intentions to leave nursing professions? Hämmig BMC Health Services Research (2018) 18:785 https://doi.org/10.1186/s12913-018-3556-1 RESEARCH ARTICLE Open Access Explaining burnout and the intention to leave the profession among health professionals – a cross-sectional study in a hospital setting in Switzerland Oliver Hämmig Abstract Background: Burnout and the intention to leave the profession are frequently studied outcomes in healthcare settings that have not been investigated together and across different health professions before. This study aimed to examine work-related explanatory factors or predictors of burnout and the intention to leave the profession among health professionals in general, and nurses and physicians in particular. Methods: Cross-sectional survey data of 1840 employees of six public hospitals and rehabilitation clinics recorded in 2015/16 in German-speaking Switzerland were used. Multiple logistic and stepwise linear regression analyses were performed to estimate the relative risks (odds ratios) and standardized effects (beta coefficients) of different workloads and work-related stressors on these outcomes and to study any possible mediation between them. Results: On average, one in twelve health professionals showed increased burnout symptoms and every sixth one thought frequently of leaving the profession.Discussion: Health Services Research Paper Temporal, physical, emotional and mental workloads and job stresses were strongly and positively associated with burnout symptoms and thoughts of leaving the profession. However, the relative risks of increased burnout symptoms and frequent thoughts of leaving the profession were highest in the case of effort-reward and work-life imbalances. In fact, these two work-related stress measures partly or even largely mediated the relationships between exposures (workloads, job stresses) and outcomes and were found to be the strongest predictors of all. Whereas a work-life imbalance most strongly predicted burnout symptoms among health professionals (? = .35), and particularly physicians (? = .48), an effort-reward imbalance most strongly predicted thoughts of leaving the profession (? = .31–36). A substantial part of the variance was explained in the fully specified regression models across both major health professions and both outcomes. However, explained variance was most pronounced for burnout symptoms of physicians (43.3%) and for frequent thoughts of leaving the profession among nurses and midwives (28.7%). Conclusions: Reducing workload and job stress, and particularly reward frustration at work, as well as the difficulties in combining work and private lives among health professionals, may help to prevent them from developing burnout and/or leaving the profession and consequently also to reduce turnover, early retirement, career endings and understaffing in healthcare settings. Keywords: Burnout, Intention to leave the profession, Health professionals, Physicians, Nurses, Switzerland Correspondence: [email protected] Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Discussion: Health Services Research Paper 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. Hämmig BMC Health Services Research (2018) 18:785 Background It is well known and has been repeatedly reported that healthcare professionals, and particularly hospital staff, face numerous hazards, precarious working conditions, high workloads and job stresses such as long and irregular working hours, physical burdens, emotional pressures, social or role conflicts, understaffing and many more. Nurses and hospital physicians in particular experience high levels of work stress as a result [1–3]. Individuals use various ways or strategies to respond to or cope with high workloads and chronic job stress. American psychologists Richard S. Lazarus and Susan Folkman in their famous and most often cited cognitive stress theory have distinguished between problem- and emotion-focused coping of stress [4]. In accordance with this theory it seems obvious and plausible that there are in principle two possible ways of coping in reaction to job stress, apart from solving the problem or rather modifying the stressful working conditions: regulation of emotions (e.g. dissociation and emotional withdrawal) or elimination of the stressor (e.g. quitting the job or leaving the profession). One way is to remain exposed to the workloads and occupational stresses and suffer from emotional and physical exhaustion at some point, and then “cool down” and distance oneself emotionally from the patients to retain one’s job functionality [1], or to “burn out”, get sick and temporarily lose one’s ability to work. Discussion: Health Services Research Paper Another adaptive strategy is to avoid or reduce prolonged work stress by changing the job or the organisation, or – if this does not help and solve the problem – by leaving the profession. It is not without reason that the burnout risks and turnover rates and intentions of physicians and nurses are among the most frequently reported challenges and studied outcomes in healthcare and hospital settings. Both stress reactions, burnout and leaving the organisation or profession, pose major challenges to the healthcare system. In fact, it has long been recognized that burnout as “a consequence of continued exposure to stressful events related to work” [5] is a common occupational disease in the healthcare professions, and that turnover rates among nurses pose a challenge to healthcare systems worldwide due to staff shortages and resulting poor patient outcomes. Accordingly, burnout and the intention to leave the organisation or the profession, or at least patient care, in response to constant work stress are frequently studied among nurses and/or hospital physicians [1, 6–23]. However, most of these studies are focused either on burnout or on the intention to leave the profession (or direct patient care) and/or on only one profession or specialty, mostly nurses or physicians. Numerous and diverse work factors and stress measures were used and studied as predictors of these outcomes, but these have not been consistent. Some studies have investigated the Page 2 of 11 effort-reward imbalance as a prominent job stress model and a predictor of burnout [15, 17, 21, 22] and intention to leave the profession [6, 18]. Others considered work-life/family conflict, interference or imbalance as a major explanatory factor for burnout [8, 15] or the intention to leave the profession [7, 11, 12, 24]. Discussion: Health Services Research Paper Burnout and the intention to leave the profession have scarcely been studied together so far, and particularly not for both major health professions (nurses and physicians) simultaneously and under consideration of different work stressors and work-related stress measures. This study therefore sought to examine the relationships between four major work stressors and two prominent and most highly relevant outcomes in healthcare settings (see Fig. 1). This was done for both nurses and hospital physicians and under consideration and the assumed mediation of two identified work-related stress models or measures [15, 25], namely effort-reward imbalance and work-life imbalance. The study aimed to answer the following research questions: Which work factors and particularly job stressors are most strongly associated with burnout? Do these work factors or stressors effect burnout more directly or indirectly, and are they mediated by effort-reward and/or work-life imbalance? Can the same contributing factors, predictive effects and direct and indirect paths be observed for the intention to leave the profession as the other outcome under study? Can any differences regarding these relationships and effects between the two major health professions be observed? Methods Data and study sample Cross-sectional survey data recorded between summer 2015 and spring 2016 among the workforces of four public hospitals and two rehabilitation clinics in Germanspeaking Switzerland, including a university hospital, a cantonal hospital and a district hospital, were used for this study. The participation by hospital employees was voluntary and anonymous. Discussion: Health Services Research Paper The overall participation or return rate of the full sample postal survey was just over 41%, ranging from 36 to 49% depending on the hospital. The written questionnaire contained exactly 100 questions (single items) or groups of questions (scales) on “Work and Health in the Hospital”. Pre-tests have shown that it took about half an hour on average to complete the questionnaire. A total of 1840 hospital employees, including 1441 health professionals, were interviewed, i.e. completed and returned the questionnaire. More than 85% of all participants and Hämmig BMC Health Services Research (2018) 18:785 Work stressors (exposure) Page 3 of 11 Work-related stress (mediator) Work-related wellbeing (outcome) Temporal work load Physical work load Emotional job strain • • Effortreward imbalance • Burnout • Leaving the profession Work-life imbalance Mental job strain Direct effect/path Indirect effect/path Fig. 1 Explanatory model for the prediction of burnout und intention to leave the profession almost 88% of the participating health professionals were women, with a female share of more than 94% among caregivers and nurses (including midwives) and almost 64% among physicians. The participants were mostly highly educated (66%) and below 45 years of age (58%). Measures Work stressors Measures of four different aspects of workloads and job stresses were used as exposure variables and predictors of burnout and intention to leave the profession, namely temporal and physical workloads and emotional and mental job stresses. Discussion: Health Services Research Paper Temporal workload was measured by the self- reported number of extra hours worked in a standard week, ranging from 0 (no voluntary or required overtime at all) over 1–2, 3–5 and 6–10 extra hours to more than 10 extra hours per week. Physical workload was assessed by asking participants for the amount of time (the whole time, three quarters of the time, half of the time, one quarter of the time or never/almost never) they spend at work a) in painful or tiring positions (poor posture), b) carrying or moving persons, c) carrying or moving heavy loads, d) standing and e) with uniform hand or arm movements. Emotional job stress was measured by the sum score of a 5-item scale taken from the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ) and with questions such as ‘Does your work put you in emotionally disturbing situations?’ (response categories: 4 = always, 3 = often, 2 = sometimes, 1 = seldom, 0 = hardly ever/never) or by asking ‘Do you get emotionally involved in your work?’ and ‘Does your work require that you hide your feelings?’ (response categories: 0 = to a very small extent, 1 = to a small extent, 2 = somewhat, 3 = to a large extent, 4 = to a very large extent). Finally, mental job stress was assessed with the sum score of five 4-point Likert scaled items selected from the 6-item subscale on over-commitment [26], also used in the COPSOQ. Items used were reports or statements of being unable to sleep at night after having left something unfinished at work, being unable to switch off from work when getting home or having a troubled mind due to work problems when waking up etc. (response categories: 0 = strongly disagree, 1 = disagree, 2 = agree, 3 = strongly agree). These items measure “the long arm of the job” and stressful work rather than excessive work engagement or over-commitment to the job as a personal characteristic or personality trait. Work-related stress Stress at work or related to work in general was assessed by two well established and validated measures of reward frustration or gratification crises at work (effort-reward imbalance) and role conflict and compatibility problems between work and private life (work-life imbalance). The effort-reward imbalance was originally conceptualized and operationalized by Siegrist and colleagues as an important and prominent stress model [26, 27] and was measured accordingly by the ERI ratio calculated from the two dimensions and the 10-item and 6-item subscales of “effort” and “reward”. Discussion: Health Services Research Paper The work-life imbalance was assessed with the 5-item work-privacy conflict scale used in the COPSOQ, a translated and adapted German version of the work-family conflict (WFC) subscale of Netemeyer et al. [28]. The scale includes the following items: Hämmig BMC Health Services Research (2018) 18:785 1. The demands of my work interfere with my home and family life. 2. The amount of time my job takes up makes it difficult to fulfill family or other private responsibilities. 3. Things I want to do at home do not get done because of the demands my job puts on me. 4. My job produces strain that makes it difficult to fulfill my family or private duties. 5. Due to work-related duties, I have to make changes to my plans for family activities. Burnout The risk of burnout was measured by the six-item personal burnout subscale of the Copenhagen Burnout Inventory (CBI), developed by Kristensen et al. [29] and Borritz et al. [30], as the most important dimension and only CBI subscale used in the standard German version of the COPSOQ. Participants were asked about the frequency of feeling tired (item 1) and drained (item 5), feeling weak and vulnerable to diseases (item 6), being physically and emotionally exhausted (items 2 und 3) and thinking ‘I can’t go on any longer’ (item 4). The response scale ranged from ‘never’ (score 0) to ‘always’ (score 4). An aggregated sum score of 16 up to the maximum of 24 was considered as constituting an increased risk of burnout. Page 4 of 11 major health professions (nurses, physicians), all health professionals and all hospital staff. Third, multivariate analyses or more specific multiple linear regression analyses were performed and standardized beta coefficients were calculated to estimate and compare the individual and independent effects of all predictors, to test for partial or full mediation in the relationship between exposure and outcome variables and to assess the explained variance (R squared) of the outcome variables. Again, these analyses were carried out for the full study sample and additionally stratified for three subsamples (nurses, physicians, all health professionals). Discussion: Health Services Research Paper Since linear and mediated associations and unidirectional and dose-response relationships were postulated (see Fig. 1) or implicitly expected and no bidirectional or hidden structures or unobservable constructs (latent variables) were assumed and had to be studied and tested, multivariate logistic and linear regression analyses have been chosen as the most appropriate statistical methods for this study. Explorative statistical methods like factor or cluster analyses, simple bivariate methods like correlation analyses or sophisticated multivariate methods like Structural Equation Modeling (SEM) would have been inadequate or insufficient or overdone in one way or another. Results Descriptive statistics Intention to leave the profession Participants were asked not only about actually considering a job change but also and even more interestingly about having thought of leaving the profession during the previous 12 months. The question included response categories from 1 (‘never’) to 5 (‘daily’). This single-item measure was used in the famous European NEXT (Nurses’ Early Exit) study and was again taken from the standard German version of the COPSOQ. Analyses First, descriptive statistics and particularly the relative frequencies of all exposure, mediator and outcome variables were calculated for the entire study population (hospital employees) as well as for the caregivers and nurses, the physicians and all health professionals separately. Second, bivariate associations between exposure variables (work stressors) and mediator variables (stress measures) on the one hand and outcome variables (burnout, intention to leave the profession) on the other were analyzed. Logistic regression analyses were then carried out and odds ratios for the more and most highly exposed persons were calculated as proxies for their relative risks of increased burnout symptoms and frequent thoughts of leaving the profession. Discussion: Health Services Research Paper All studied associations were adjusted for sex, age and education. Additionally, the analyses were stratified for the two Descriptive statistics have clearly shown the expected high temporal workload of physicians and the well-known high physical workload of caregivers and nurses (see Table 1). More than one third of physicians reported regular overtime of six or more hours per week compared to only 3% among caregivers and nurses and 8% among all hospital staff (including physicians). In contrast, caregivers and nurses showed a high or very high physical workload in 50% of the cases whereas this proportion was only 13% among physicians. Descriptive results also revealed the comparably (very) high emotional job stress of health professionals in total (59%) and particularly of physicians (70%), as well as the (very) high mental job stress of physicians (46%) compared to all hospital employees (33%). As a consequence, slightly or strongly increased stress levels were found for caregivers and nurses in terms of a (very) high effort-reward imbalance (71% vs. 64% among all hospital employees) and for physicians in terms of a (very) high work-life imbalance (68% vs. 33% among all hospital employees). However, no significantly increased burnout symptoms or thoughts of leaving the profession were found for caregivers and nurses and only an increased proportion of physicians with an elevated burnout risk (13% vs. 8% among all hospital employees) became evident (see Table 1). As regards the differences between the two major health professions, physicians showed a significantly higher prevalence rate of being at increased risk Hämmig BMC Health Services Research (2018) 18:785 Page 5 of 11 Table 1 Workloads and job stresses, work-related stress measures and well-being among health professionals in particular and hospital employees in general Caregivers & nurses (incl. midwives) Physicians All health professionals Total hospitalDiscussion: Health Services Research Paper employees N = 882 N = 235 N = 1441 N = 1840 No regular overtime 40.0% 19.1% 35.3% 37.5% 1–2 long hours/week 42.7% 22.6% 39.4% 37.0% Temporal workload 3–5 long hours/week 14.6% 24.8% 16.9% 17.5% 6+ long hours/week 2.7% 33.5% 8.4% 8.0% Low (0–1) 7.9% 29.7% 15.3% 17.8% Medium (2–5) 42.6% 57.2% 47.1% 46.6% High (6–10) 39.1% 12.2% 30.3% 28.6% Very high (11–20) 10.4% 0.9% 7.3% 6.9% Physical workload Emotional job stress Low (0–5) 5.0% 1.8% 6.8% 12.6% Medium (6–10) 35.7% 27.9% 34.1% 35.5% High (11–15) 54.7% 64.6% 54.4% 47.6% Very high (16–20) 4.6% 5.8% 4.7% 4.3% Low (0–5) 27.9% 15.4% 24.8% 26.5% Medium (6–7) 42.1% 38.2% 41.2% 40.1% High (8–9) 23.4% 34.6% 26.3% 25.7% Very high (10–15) 6.7% 11.8% 7.6% 7.7% (Very) low (?0.8) 7.4% 11.7% 10.3% 12.5% Moderate (> 0.8–1.0) 22.2% 23.4% 23.0% 23.9% High (> 1.0–1.5) 56.0% … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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