Browsing by Author "Nelson, John W."
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- ItemAdding an integrative health and wellness assessment of nursing staff to the caring science research trajectory in a mid-size hospital in Wyoming, USA(2012-9-12) Nelson, John W.; Zeta
Four hundred nurses in a large community hospital in Casper, Wyoming, USA have been involved in the implementation of a Caring Science program since 2005. This research trajectory of Caring Science that is using a longitudinal research design began by measuring nurse's perceived competence in caring using the Caring Efficacy Scale in 2005. Measurement of patient's perception of caring was begun in 2008 by using the Caring Factor Survey based on Watson's Theory of Caritas. Now in 2012, the measurement of self-care has begun. According to Watson's Theory of Caritas, caring for others must begin by caring for self. The Integrative Health and Wellness Assessment (IHWA)* was used to assess eight concepts of self-care as proposed by integrative nurse coach experts Barbara Dossey, Susan Luck and Bonney Gulino Schaub. The IHWA assesses ten concepts of self-care (Life Balance and Satisfaction, Relationships, Spiritual, Mental, Emotional, Physical (Nutrition, Exercise, Weight), Environment, Health Responsibility). Over the last 23 years, it has been refined based on respondent feedback and associated theoretical evolution proposed by Dr. Dossey. The survey assesses both current and desired state of self-care. Each of the eight concepts ends with asking the respondent to list three things they can do for self-care that relates to the concept of self-care on that page of the survey. This session will review staff variance of current to desired state and identify the most commonly reported self-care strategies of the 400 nurses from this study. * Source: © 2011. Dossey, B. M., Luck, S., & Schaub, B. G. Nurse Coaching for Health and Wellness. (Huntington, NY: International Nurse Coach Association. (www.integrativenursecoach.com). In Dossey, B. M., and Keegan, L. (2012) Holistic Nursing: A Handbook for Practice (6th ed.). Burlington, MA: Jones & Bartlett Learning. The format is designed for survey software of Healthcare Environment (www.hcenvironment.com).
- ItemThe effect of civility on the healthcare environment, staff, and the care of patientsNichols, Tara M.; Nelson, John W.; Trinity Health System, Grand Rapids, Michigan, USA; Rho
This session reviews research on the implementation of Relationship Based Care to facilitate cultural transformation. This study identified civility is important in creating a healthy work environment.
- ItemIntegration of caring science research across settings and implications for practice(2016-03-17) Felgen, Jayne; Nelson, John W.
Session presented on Sunday, July 26, 2015:
This session will provide a review of the six research studies presented in the Caring international Research Collaborative (CIRC) special session. Attendees will first review the resultant path analysis (flow of data results) from each study presented to examine similarities of practice across settings, contexts and countries. This session will be delivered within the concepts of transparency, collaboration, caring science, and operations of clinical practice. Sharing of science, according to Dr. Thomas Kuhn as a pioneer in modern science, reports is what makes new discovery possible. Each of the research models reveal antecedents, covariates and outcomes that occur within the process of care. An examination of each model and comparison of models reveals certain variables and findings may have broad application within the process of care. Despite the similarities, each model has been specified to the context where the research occurred which resulted in unique dimensions of measurement and associated operations considerations. Model specification was important to minimize error in the results of the study and provides insight into how each context, culture and combination of both create challenges in replication with concomitant opportunities for discovery in data. Following the presentation of the models from each of the six studies presented will be an interactive discussion that will include collaborative interpretation and discussion of implications of findings across the models of research. Interactive learning has been shown to enhance not only the learning experience but the retention of concepts learn. Attendees can plan to come prepared to exchange thought and give interpretation of the data in consideration of their own context of care. Attendees will have opportunities to consider variables that may need to be measured within their own organization to ensure the data is both reliable and specified to their unique context of care. The interactive approach that will be used will make the collaborative learning both enjoyable and deepen the learning.
- ItemA multistudy validation of an instrument for nurse job satisfaction(2015-12-07) Nelson, John W.; Persky, Georgia J.; Hozak, Mary Ann; Albu, Alice; Hinds, Pamela S.; Savik, Kay; Zeta
Objective: This study aims to validate an instrument of nurse job satisfaction, the Healthcare Environment Survey (HES), across settings and time through an organizational change.
Methods: This is a retrospective study that consisted of four phases of analysis using factor analysis to test the 59-item HES, which was initially developed in 2001 to assess nurse job satisfaction. A sample of 4,626 nurses was used from 10 unique studies that were conducted from 2006 to 2012 in four health care entities in the United States. Inclusion criteria were that the respondents had to provide direct care to patients and be permanent staff members of the entity under study.
Results: In phase 1, the principal component analysis (PCA) for each of the 10 studies revealed a 10-factor structure of nurse job satisfaction that was consistent across settings and time. Half of the sample from all 10 studies was randomly selected and reexamined in an exploratory factor analysis (EFA) that revealed a nine-factor solution using 50 items with a Kaiser–Meyer–Olkin of .96. All items loaded in the same respective factors as those of the previous PCA analyses. The EFA explained 74% of the variance. A confirmatory factor analysis of the other half of the sample confirmed the nine-factor solution, using 50 items, with the root mean square error of approximation of .056, comparative fit index of .919, and standardized root mean square residual of .042.
Discussion: The validation of this 50-item measure of job satisfaction, which is valid across settings and time, will assist in minimizing error while building models of research that include antecedents, correlates, and outcomes of nurse job satisfaction.
- ItemNurse job satisfaction research: A literature review, 2006–2011(2015-10-26) Nelson, John W.; Hozak, Mary Ann; Albu, Alice; Thiel, Linda; Zeta
Objective: This literature review aims to evaluate the state of nurse job satisfaction research by identifying the instruments and scientific rigor used to measure the latent construct of nurse job satisfaction around the globe, during the years 2006–2011.
Design: A systematic review of research articles in measurement of nurse job satisfaction.
Data Sources: Medline, Cumulative Index to Nursing and Allied Health Literature, Social Sciences Citation Index, Ingenta Connect, and Web of Science.
Review Methods: The years 2006–2011 were selected as a time frame that would provide a large number of studies from around the world and consider past measurement in nurse job satisfaction. Articles were included that identified a measure for nurse job satisfaction and sampled nurses who provided direct patient care. Language was limited to English. Fink criteria were used to create an extraction tool to score 21 scientific criteria in the measurement of nurse job satisfaction.
Results: The literature review generated 1,681 articles, from which 995 articles were selected for further review; of these, 104 unique articles addressed measurement of nurse job satisfaction using 56 unique instruments. A total of 149,905 nurses from 35 countries responded to inquiries about job satisfaction. The extraction tool revealed scores from 8.00 to 18.00 (out of 21 total possible points) with a mean score of 12.06 (s.d. 2.12). Criteria that fell below 50% across studies included inclusion criteria (6% of studies), non-responders explained (7%), missing data explained (11%), power analysis (16%), random sampling (29%), inclusion criteria (32%), analysis of instrument factor structure (34%) definition of nurse job satisfaction (48%) and use of theory or conceptual framework (49%).
Conclusions: This literature review revealed both successes and critical gaps in the research of measuring nurse job satisfaction. Identification of gaps in the scientific process of measurement of nurse job satisfaction may assist with refinement of instruments used to measure nurse job satisfaction that in turn will facilitate model specification around the globe.
- ItemParallel and factor analysis for delimiting items in a three-dimensional construct of clarity for nurses(2016-10-21) Felgen, Jayne; Nelson, John W.; Lambda Kappa
Introduction: Clarity of Self, Role and System is a newly developed tool that measures clarity for patient care providers as it relates to self, role and system. The instrument is based on work by Jayne Felgen and Mary Koloroutis. The “Clarity of Self” subscale was derived from another 40-item instrument that was established by Campbell et al. (1996). The other two subscales, “Clarity of Role” and “Clarity of System,” were co-created by the authors.
Aims/Objectives: The purpose of this study is to decrease the number of items that respondents are required to respond to, while maintaining the validity of the construct.
Materials & Methods: Parallel analysis and factor analysis were performed by Healthcare Environment using SPSS software 22.0 and Brian O-Connor’s SPSS syntax.
Results/Discussion: Four items were removed from the original 29-item survey, resulting in a new 25 item instrument. It was assumed that more items would be identified as candidates for deletion. However, extensive study of the factor structure revealed this not to be possible. Rather, several items for each dimension of clarity were required to have a valid measure of clarity of self, role and system. Although the authors were disappointed that more items could not be eliminated, this study did provide rigorous analysis for discussion of the results. Most helpful was a discussion of the adequacy of this instrument to measure clarity as it was originally articulated by Felgen and Koloroutis.
Conclusion: This item reduction study did not completely provide its intent, but it did reveal that a re-specification of the measure of clarity is warranted. Items need to be added for both “Clarity of Role” and “Clarity of System.” Additionally, a new subscale for measuring clarity of self will need to be developed to more precisely measure the theory of clarity as proposed by Felgen and Koloroutis.
- ItemRelationship between HCAHPS scores (patient experience) and Watson’s Theory of Caring(2016-11-10) Nelson, John W.; Hozak, Mary Ann; Zeta
The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey measures patient experience. It is an important survey because some of the hospitals’ payment is dependent on the scores. It was desired to know if use of caring theories could increase HCAHPS scores. No study was found that examined the relationship between HCAHPS and the construct of caring as proposed by Watson. Patients in a 650 bed urban acute care hospital in the Northeastern portion of the USA were studied (n = 233). A statistically significant relationship was found (r = .86, p = < .001). Findings have implications for using caring science as an intervention to improve HCAHPS scores.
- ItemSelecting variables of study aligned with models of caring(2016-03-17) Nichols, Tara M.; Bywater, Janina Sweetenham; Nelson, John W.
Session presented on Sunday, July 26, 2015: This session will have two sub-sessions each reviewing a unique model of care. The first model of care, Caring Behaviors Assurance System (CBAS), is currently being used in about 50% of the National Health Service (NHS) of Scotland. Caring, as proposed by Swanson's theory, was selected as a construct for measurement as it is proposed as a primary variable of quality of care. Development of a context of caring, using a formal model of care to structure operations and data analyses, was proposed to positively impact both patients and employees. A key strategy to make caring real operationally is use of a Patient-Centered Care Quality Instrument (PCQI) form. Staff select a specific behavior from the PCQI to operationalize on their respective ward or department. Caring and quality as reported by patients and staff will be reviewed in this session as it relates to use of the PCQI. This session will review the current model of research that has been developed and refined over the last 30 months as concept and operations of caring are more clearly understood in relationship to outcomes of quality care. The second sub-session will review a study from within the context of Relationship Based Care. Participants within a caring science research program in this acute care hospital in Michigan have been working within the context of Relationship Based Care. Similar to the NHS of Scotland, a model of research has been taking form and refined as the model of Relationship Based Care has been implemented. During the development of research and operations of caring science, it became clear that the construct of civility needed to be studied. This understanding became clear as staff and managers evaluated the initial data in consideration of relational and environment challenges of the work environment. This session will review what was discovered regarding the relationship of civility with the work environment and outcomes of quality and caring.
- ItemSelf-care while caring for others as a strategy to improve reflection and clarity of self(2012-9-12) Nelson, John W.; Zeta
This 2-hospital system, which includes one of the first fifteen hospitals to achieve and sustain Magnet certification in the USA, began implementation of Relationship Based Care (RBC) three years ago. According to the concepts of RBC, employees must have clarity in their own strengths and vulnerabilities as they execute their role in caring for others. The challenge within the current pace and intensity of healthcare is the environment and employees do not pause long enough to support self-reflection for employees to establish or maintain clarity of self as they care for others. Thus, the organization implemented and tested interventions to improve the environment of for self-care and reflection. The first strategy focused on the internal environment of the employee. An educational program regarding how to use self in the healing of others was implemented. Nurses volunteered to become educated as practicing holistic healers with the full support of the executive administration and medical staff. The second strategy focused on the external environment of the employee. A major renovation of one of the hospitals was planned. Prior to the renovation, the structure was examined in relationship to employee self-care. Watson's Theory of Caritas, Architectural theories, and empirics were used to design the data collection tool. It was desired to understand how the current structure, prior to renovation, related to employee's report of self care. Data was used to examine self-care scores of staff and how the structure related to scores of self-care in each unit and department. It was proposed that everybody can create a caring moment for self and others, thus everyone in the facility was included in studying self-care and the impact on caring. The organization proposed the cumulative effect of caring moments with everybody in the organization will impact outcomes of employees, patients, and the organization.
- ItemStructuring caring science data for operations and outcomes.(2014-11-17) Nelson, John W.; Brown, Jacqueline
Session presented on Sunday, July 27, 2014:
This session includes two sub-sessions regarding how caring science is structured for culture and context. The first portion of the presentation will focus on how caring is structured using frameworks like Relationship Based Care, Planetree, and Caring Behaviors Assurance Strategy (CBAS). The second portion of the presentation will review how the structure of caring was established in 75% of the hospitals in Scotland using CBAS. Structuring data based on a model of care deliver like Relationship Based Care, Caring Behaviors Assurance System, Planetree, or other care delivery systems can assist with data management. Using a model of care delivery system to structure data can assist with measuring the predictors and outcomes proposed to be impacted by the model of care. Structuring data in this manner can organize complex data for the purpose of interpretation and application of data. This session will provide examples from organizations that use structural phenomenology to structure the study of caring within specific models of care delivery, specifically Relationship Based Care (RBC), and Caring Behaviors Assurance System (CBAS). A deeper examination of one of the models of care delivery, CBAS, will give an overview of person centred healthcare across Scotland, specifically focusing on the seven aspects of quality identified as most important by patients through surveys and feedback. Referred to as the 7 C's; caring, compassion, collaboration, clear communication, clean environment, continuity of care and clinical excellence. The Chief Nursing Officer for Scotland requested designing of a system that would assess caring and compassion at the patient interface; provide one to one feedback and development to staff on findings; deliver a cultural change program measured against a set of owned and agreed caring and compassion standards; create a system of reporting from ward to board and introduce a program to address caring for staff and building a resilient workforce. This work was commissioned by the Chief Health Professions Office for NHS Scotland, and overseen and coordinated at the Executive Nurse Director level. The presentation will demonstrate how this program has been developed and where at local ward and hospital level, measures of caring are monitored alongside interventions of care and patient and staff outcomes.
- ItemStudying HCAHPS scores and patient falls in the context of caring science(2016-03-17) Nichols, Tara M.; Hozak, Mary Ann; Nelson, John W.
Session presented on Sunday, July 26, 2015:
This session includes two sub-sessions regarding examination of critical outcomes within care that were identified as both regulatory and financial stressors. Each organization used path analysis derived from a caring science research program to identify which critical outcomes could be studied within the building model of caring science research. Both studies are from acute care hospitals in the USA but have wide application across the globe, to any hospital seeking to improve outcomes within the context of caring science. Within the first path analysis, it was identified the patients perception of caring (using Watson's theory of caring) was impacted by staff who were clear in their professional role and the organizations' system which in tuRNupported creation of a work structure that they could successfully make the patient feel cared for. If the research model could reveal how the context of caring impacted the patient's report of caring, it seemed like a logical next step to show how this impacted patient satisfaction as measured by the HCAHPS scores. To most deeply understand the context and data relating to HCAHPS scores, a mixed method study was applied. The first of the three methods examined the relationship of caring, using Watson's theory of caring, with five slightly reworded HCAHPS questions (with permission of the CMS). HCAHPS questions address the patient's perception of pain, pain management, feeling listened to by staff, education on new medication and discharge instructions. The second method used a semi-structured interview of a panel of nine patients had been hospitalized in this hospital. Patients were selected for the panel because they had provided an HCAHPS score of 7 or 8 but not 9 or 10. It was desired to know where the hospital fell short in the patient reporting the highest scores of care. Finally, a secondary correlation analysis was conducted of HCAHPS scores from approximately 9,000 patients to understand if a profile high HCAHPS scores could be produced. Results provided a contextual understanding of HCAHPS. The second sub-session also used a path analysis within a caring science program to understand the structure of caring science data. This hospital, similar to the hospital studying HCAHPS in the first half of this session, used Relationship Based Care, Watson's Theory, and was an acute care hospital. The similar context may explain a similar model of staff who had clarity of role and system were also the staff who reported a good work environment (relationally and technically) to make the patient feel cared for. However, this study has some unique behavior in the staff data and subsequent path analysis that encouraged conversation of what might be missing in the model of research. This process of respecification of the model revealed the concept of civility needed to be added as it was suspected the lack of civility (may be referred to as bullying) in some areas of the hospital was impacted the path analysis. The theory of civility proposed by Kathleen Bartholomew was used to study if civility did fit in this model and thus explain some of the variation in these data that had a context very similar to the hospital that studies the HCAHPS scores. Presenters of this study will review the civility, or lack of it, discovered in the hospital staff and how this impacted the model. Presenters will also review what actions were taken to address operationally what was discovered within this research.
- ItemTesting a model of civility in three service lines of acute care(2013-05-13) Papa, Ann Marie; Nelson, John W.; Bartholomew, Kathleen; University of Pennsylvania Health System, Philadephia, Pennsylvania, USA; Zeta
Session presented on Sunday, April 14, 2013:
This study was conducted to assess a model of civility proposed by the concepts proposed by Kathleen Bartholomew. The model was tested in three service lines at the University of Pennsylvania hospital, including Women's Services, Periop, and Emergency Services. Civility is characterized by a culture of respect among a team that automatically polices itself to inhibit and extinguish any single act of cruelty, slight, or diminishment of another. Civility was assessed using the 87-item Civility Assessment which is based on the concepts of civility proposed by Kathleen Bartholomew. The Civility Assessment examines the 17 concepts that comprise the construct of Civility.
- ItemTesting a model of clarity of self, role, and system as predictors of job satisfaction of nurses in Jamaica(2012-9-12) Anderson-Johnson, Pauline; Nelson, John W.; Zeta
Research in job satisfaction has positioned the organization as the primary entity responsible for improving the work environment. This study tests a model that positions the individual nurse as the primary source to create their own satisfying job. Creation of a satisfying job begins with being clear in self, role, and system. Clarity of self facilitates nurse understanding what they can and cannot do so they can collaborate with others in the work team who has strengths which they lack while at the same time accelerating in their individual strengths. Clarity of role facilitates efficient and safe use of their own role while understanding how to maximize the role and collaboration of other professionals. Clarity of system allows the nurse to tap into resources needed to maximize the use of self, within their role, to care for the patient. Clarity of self, role, and system will also assist with the nurses stating what their need is within their respective role to create resources needed within patient care. Participative Action Research (PAR) was used to make the findings actionable with staff. PAR is a process where analysts/researchers, management, and staff all work together to interpret and apply findings. Data from this study was presented to every unit/ward in the University hospital so staff and management could interpret and action plan around the findings. This presentation will review the model fit of how clarity of self, role, and system predicts the latent variable of job satisfaction as well as each facet of job satisfaction. The presentation will also review how the organization used the staff's articulated clarity of self, role, and system to create their own action plans on building and refining the structure and infrastructure to meet the needs articulated by staff clear in self, role, and system.
- ItemUse of Caring Theory in Culture and Context in Scotland and Cameroon(2014-11-17) Nelson, John W.; Moffor, RelindisSession presented on Sunday, July 27, 2014: This session includes two sub-sessions regarding how caring science theory was selected and used in two different cultures and context. The first sub-session will review how Swanson's theory of caring was a better fit for the culture of Scotland than was Watson's theory. The second sub-session will review how Watson's theory of caring science was used to assess the farming needs of women living with AIDS a village in Cameroon, Africa The first portion of this session will review how two different theories of caring were tested for the purpose of developing a caring science model of research that was appropriate for the context of Scotland. Theoretical models that fit the context are important to minimize error in data and maximize the ability to implement findings operationally in clinical care. This presentation will review how Watson's and Swanson's theory in caring science were both tested and how a decision was made to use Swanson's theory for examining caring science in an acute care hospital in Scotland. Central within the discussion was the discussion of measuring spirituality within the construct of caring. Results will identify how measures and interventions related to caring science must match the culture. The final model that used Swanson's theory and addressed spiritual needs of the patient population will be presented. Presenters of this session were asked by an international agronomy research group to assist with innovative ways to assess food sustainability in vulnerable populations. A village in Cameroon, comprised of women living with AIDS, was selected to evaluate how caring science could be used to not only assess the farming needs, but to assess if caring might enhance their CD4 counts. A pilot study was conducted, using Watson's 10 concepts of caring, to assess needs related to farming and food sustainability within the village. This presentation will review the results from the pilot study, the process of implementing findings from pilot study and plans for ongoing interventions and research to support these women who are living with AIDS in Cameroon.
- ItemUsing pause and flow (physics) as a method to improve the experience for staff and patients(2016-03-17) Hozak, Mary Ann; Bywater, Janina Sweetenham; Nelson, John W.
Session presented on Sunday, July 26, 2015:
Constructal Law has been used in multiple sciences to illustrate how design can impede or enhance flow. This session will reveal how Constructal Law, physics, was used to study the design of the work environment as reported by staff and the care experience as reported by patients. The first half of this session will examine the work of staff from the USA who conduct care on wards in an acute care hospital with persistent excellent scores of performance. Use of statistics to show ward performance was limited once the best scores were achieved and sustained. There was a desire the staff in these wards to show performance beyond the 95th percentile. Use of statistics in various graphs like bar charts and box plots to show persistent high scores was deemed wanting as it did nothing to shed light on what caused the operations on the high performance units to work well. Based on the limitations of data, it was decided to apply a different kind of mathematics to reveal the design of good functioning units. The process of studying the flow and pause of the work design was achieved through application of Constructal Law. It was a study of the design of work which provided very useful information to go beyond the 95th percentile. Also within the first half of this session, methods will be reviewed how this method of analysis was used to support continued refinement of high performing units. Presenters will identify how the data was generated, dissemination to staff, and used for refining operations. This method was found to engage staff because the staff comments about the process of work was validated by making their views visible and operational for change. This first sub session will also review how this concept has been applied to low performing units as well. The second half of the session will review how Constructal Law was applied to studying the process of caring for patients who reported nothing else could be improved. It was desired to continue the deepening of the caring process that was limited by the current use of statistics' graphing and reporting. Studying the design of successful caring, using an analysis of pause and flow, too place in an acute care hospital in Scotland, within the National Health Service (NHS). Likert scales within a measure that used Swanson's theory of caring was supplemented with the patient's report of what felt caring and what did not feel caring. This analysis of pause and flow revealed specific operations that could be used to enhance the process of caring as reported by patients, despite the patients' report of nothing needing improvement.