Purpose | Location, Sample & Measurements | Findings | Authors |
Examine patterns of RN involvement in organizational decision activities |
- Texas
- 125 for profit nursing homes
- Administrators & DONs completed survey
- Ratings given for RN involvement:
- - decision areas
- - decision activities
- - mechanism of involvement
|
- RN decision areas:
- #1 = tactical-resident care
- #2 = tactical non-resident areas
- #3 = strategic-operations
- #4 = strategic marketing.
- Primary decision activity
- = raising the issue;
- Least used activity
- = choosing the alternatives.
- Most frequent mechanism
- = informal meetings, established committees & chance encounters
|
Anderson & McDaniel, 1998 |
Identify relationships between burnout, empathy and attitudes toward demented patients |
- Sweden
- 60 nurses in geriatric & psycho- geriatric care
- Surveys twice, with 1 year between
- Semi-structured interview & Likert ratings:
- Pine's Burnout Scale, Empathy Scale, Attitudes Towards Demented Patients Scale
|
- Empathy - moderately high scores
- Burnout correlated with lower empathy & less positive attitudes
- Staff with high empathy identified the most stimulating job factors
as close contact with patients
- Staff with low empathy identified most stimulating job factors as improvement in
patient's health & contact with colleagues
|
Astrom, et al., 1991 |
Explore work excitement in home care nurses. |
- Southeastern United States
- 6 urban and 3 rural home care agencies, 167 nurses
- Survey with multiple choice answers
|
- 71% of nurses were moderate to very excited
- Highly Excited Nurses'
- Most exciting aspects of work were:
- able to make difference in patients' lives, important
part of healthcare team, working with people.
- Most meaningful accomplishment:
- improved patient outcomes
- Most frequent frustrations:
- staffing, time management, work completion and documentation
- Chose home healthcare for reasons of personal fulfillment
- Less Excited Nurses selected home health because of flexibility and scheduling
|
Baldwin & Price, 1994 |
Explore relationship between job empowerment & perception of immediate manager, &
organizational commitment |
- Ontario, Canada
- 2 nursing homes
- 212 supervisors, RNs & LPNs
- Survey with scales of work effectiveness, organizational
commitment & job empowerment
- Likert response sets
|
Nurses who saw their supervisor as upward and outwardly influential perceived their
own status as enhanced by association
RNs and LPNs significantly less empowered and
committed to organization than supervisors. |
Beaulieu, et al., 1997 |
Discover coping strategies employed by nurses |
- Netherlands
- 2 nursing homes
- interviews with all disciplines & nurses, residents and families
- - 70 interviews & 5 months of observation & discussions
|
- Found two sets of types of strategies:
- Standardization, normalization and avoidance -
good for efficiency
- Consultation, acceptance - good for responsiveness to resident
|
Boeije, et al., 1997 |
Determine home care nurses' satisfactory and unsatisfactory job components |
- Iowa & South Dakota
- Interviews
- 25 N.H. nurses;
20 homecare nurses; 5 ALF nurses
- open ended questions and satisfaction scale;
Likert responses set
|
- Satisfactions: found in nurses from...
- Caring for patients NH, ALF, HC
- Doing worthwhile work NH, ALF, HC
- Knowing pts long time NH, ALF
- Giving pts solo attention HC
- Independence in practice HC
- Dissatisfactions:
- Clients don't get enough care NH, ALF, HC
- Low staffing NH, ALF
- Documentation demands HC
|
Buelow & Crujissen, 2002 |
Top of Page |
Identify what attracts nurses to home care, keeps them there, & provides personal rewards |
- Southeastern state
- 2 home care agencies
- 25 nurses observed & interviewed during home visits, 300 hours
- Open ended questions
|
- Satisfying themes:
- Independent practice, intellectual challenges, respect from physicians,
schedule own time, family relationships
- Experiences most satisfying - often a challenging case successful with.
- Enjoyed outwitting the system, co-workers & recognition
|
Chubon, 1991 |
Identify factors contributing to nurses' stress & satisfaction |
- Large metropolitan area
- 30 RNs, LPNs & NAs;
- two units of nursing home
- Rated event & intensity of stress or satisfaction for 10 days
|
- Satisfaction centered on:
- 1-patient care & helping role;
- 2-relationships with co-workers
- Stress centered on:
- unit level, work overload, co-workers, supervisors, institutional policies & benefits
|
Cohen- Mansfield, 1989 |
To compare job satisfaction areas of hospital versus home health care RNs |
- Southern Alabama
- 3 home care agencies
- (64 RNs)
- 1 large metropolitan medical center,
general units
(58 RNs)
- Job satisfaction survey by Porter and Lawler, revised by Heda
- Likert scale responses
|
Home care nurses more satisfied than hospital nurses, but neither highly satisfied.
| Mean Scores |
| Home Health | Hospital |
Involvement | 27.0 | 24.9* |
Intrinsic satisfaction | 28.0 | 26.4* |
Extrinsic satisfaction | 28.4 | 27.8 |
Interpersonal satisfaction | 24.2 | 23.8 |
- Range 12-48
- 12 =total dissatisfaction,
- 30= neutral satisfaction and
- 48= perfect satisfaction.
- * = significant difference
|
Curreri, et al., 1985 |
Explore nurses' perceptions of industry changes and impact on practice |
- Massachusetts
- 16 home care nurses with 5 to 19 years experience
- 6 Focus groups
- Content analysis of transcriptions.
|
- Changes in patient population
- 1. Patient increase in acuity & need
- 2. New categories of patients
- Changes in nurse response
- 1. New focus on patient care
- 2. Increasing stress & responsibility
- 3. Pride in advocacy & clinical skills
- 4. Feel home healthcare is last positive place to practice
- 5. Acceptance & resiliency
|
Ellenbecker & Warren, 1998 |
Identify factors associated with the intentions of nurses to leave their jobs |
- Northeastern Florida, urban & rural areas
- 26 nursing homes
- 281 nurses
- Job satisfaction & Intent to leave scale /w Likert response set
|
Significantly Different factors
| Intent to Leave |
Intent to Stay |
Years in community | 11 | 19 |
Supervisor interested in career | 38% | 80% |
Friends among staff |
None | 24% | 23% |
One | 22% | 10% |
2-4 | 36% | 33% |
5 or more | 18% | 34% |
Job Satisfaction with |
Professional status | 66% | 88% |
Autonomy | 67% | 84% |
Interactions with nurses | 48% | 82% |
Pay | 35% | 53% |
Intended to stay at hiring |
< one year | 14% | 7% |
1 - 4 years | 36% | 18% |
until better job | 14% | 8% |
indefinitely | 36% | 67% |
|
Francis- Felsen, et al., 1996 |
Provide insight into home care nurses' thinking processes as plan care for chronically ill clients |
- South Carolina
- 5 home care nurses
- interviewed 20 times
- During travel between visits nurses "thought out loud" recorded/coded
|
- Cognitive operators found as foundation for understanding clinical situations
Cognitive Operators =
- Connecting - connections among cues
- Describing - give details of situation
- Evaluating - consider presence or absence of cues to standard
- Judging - formulating conclusions
- Planning - formulating future actions
- Cognitive strategies = cue logic, framing, hypothesizing, testing,
reflexive comparison & prototypical case reasoning
- Goal oriented strategy guided ambiguous thinking
|
Fowler, 1997 |
Top of Page |
Identify burnout in nurses, differences in nursing home versus hospital nurses |
- Pacific Northwest
- 3 hospitals & 7 nursing homes
- RNs & LPNs
- Mail survey,
Maslach Burnout Inventory
|
Nurses experienced moderate levels of burnout in emotional exhaustion & depersonalization
No significant differences between nursing home and hospital nurses |
Hare & Pratt, 1988 |
Determine if specific characteristics correlate to satisfied, long- tenured home care nurse |
- California
- 53 home care nurses
- Survey with multi-item scales, in 4 areas:
- autonomy,
- clinical skills,
- organizational abilities &
- satisfaction
|
- Nurses who possessed these four characteristics experienced job satisfaction,
were in job for at least 2 years & planned to stay in job
- Nurses dissatisfied with paperwork requirements and amount of time provided to do their job
|
Hilgendorf, 1996 |
Explore relationship between supervisor concern, job satisfaction, involvement &
propensity to stay with home care agency |
- Southwest USA
- One large home care agency
- 52 RNs & LPNs surveyed
- Scales with Likert response set
|
- Regression Analysis Findings:
- Nurses with high job satisfaction significantly influenced by perceived
concern by supervisor
- Nurses with propensity to stay significantly influenced by perceived concern by supervisor
|
Hood & Smith, 1994 |
To examine differences in clinical practice of home care, public health and hospital nurses |
- Illinois
- 379 home care nurses
- 387 hospital nurses
- 389 public health nurses
- mail survey
|
- Homecare nurses spent
- 62% of time with direct patient care
- 13% on administrative activities
- 14% with consultant activities
- Home health nurses performed more health histories,
physical exams, psychosocial exams and nursing diagnosis than hospital or public health nurses
- Perform health histories on majority of patients
- 79.5% of home health nurses
- 64.4% of hospital nurses
- 76% of PHNs
|
Huges & Marcantonio 1993 (dec) |
Examine differences in nurses employed by proprietary versus nonprofit nursing homes. |
- Illinois
- Nursing home RNs
- 1,269 Nonprofit RNs
- 1,582 Proprietary RNS
- mail survey
|
- Both spent most time with
- 1. Direct resident care (42-44%)
- 2. Staff supervision (30%)
- 3. Administrative activities (26%)
- Nonprofit RNs spent less time consulting other agencies
and health professionals.
- Nursing hourly wages did not vary with ownership
- Benefits better for nonprofit RNs -
- pension plans: 41% versus 18%
- dental insurance: 32% versus 25%
- health insurance: 60% of both groups
- child care: 1% of both groups
|
Hughes & Marcantonio 1993 |
Determine job satisfaction areas within rural home care. |
- North Dakota
- 111 public health & 146
home care nurses
- Mail survey
- Job satisfaction & importance scales with Likert response sets
|
Scores with highest ratings |
| Satis. | Importance |
Professional status | 4.00 | 4.47 |
Interactions | 3.87 | 4.43 |
Autonomy | 3.85 | 4.28 |
Overall satisfaction | 3.78 | 4.50 |
Organizational climate | 3.43 | 4.26 |
Total satisfaction | 3.37 | 4.26 |
Task requirements | 2.96 | 4.07 |
Benefits/ rewards | 2.77 | 4.04 |
Salary | 2.64 | 4.37 |
|
Juhl, et al., 1993 |
Top of Page |
To identify factors that facilitate positive changes in dementia care in nursing homes |
- Midwestern state,
dementia care conferences
- 181 nursing home employees, primarily nurses
- Card sort for facility & personal characteristics to facilitate positive changes
in care; sorted by ideal and then real in their facilities
|
Most important factors (scale= 1-50): |
| Facility: |
| Ideal | Real |
Staff work as a team | 1 | 17 |
Enough time to give good care | 2 | 28 |
Staff spend time with resident, not just get work done |
4 | 26 |
Time more than physical needs | 4 | 31 |
Staff support by administrators | 5 | 21 |
|
Personal Factors |
| Ideal | Real |
Truly like residents | 1 | 3 |
Flexible | 2 | 16 |
Caring & kind | 3 | 1 |
Calm | 4 | 14 |
Positive attitude | 5 | 12 |
|
Kovach & Krejci, 1998 |
Determine job satisfaction areas of home care nurses |
- Pennsylvania & New Jersey metropolitan areas
- 3 home care agencies
- 66 nurses
- Survey /w sealed envelopes
- Satisfaction Scales with Likert response sets
|
- Overall job satisfaction was high
- Very satisfied with: autonomy &
independence, close client relationships
- Dissatisfied with: child care,
maternity leave; socialization at work
- Very Dissatisfied with: praise & recognition;
control & responsibility.
|
Lynch, 1994 |
Identify relationships between work stress & job satisfaction in home care
& acute care nurses |
- Washington D.C. & Midwestern states
- 328 home care &
acute care nurses
- Mail surveys with scales for: stress, self-esteem, job satisfaction
and social intimacy (= unloading of stress)
|
- Nurses with higher job satisfaction had lower work stress,
higher self-esteem & higher social intimacy
- For home care nurses:
- Highest stressors were:
- 1-no time for all activities & charting
- 2-watching patients suffer,
- 3-documentation for reimbursement
- For hospital nurses:
- Highest stressors were:
- 1-not enough staff to cover unit
- 2-unpredictable staffing & scheduling
|
Moore & Katz, 1996 Moore, et al., 1997 |
Examine nurses' experiences as they change from hospital to home care nursing |
- Midwestern state
- 3 home care agencies
- 25 nurses who switched to home care in last 6 months
- Open-ended interviews, tape recorded & analyzed
|
Nurses had little understanding of differences between home and hospital
nursing prior to the change
Experienced increased stress when visited
clients outside their general practice area. |
Murray, 1996 & 1998 |
Describe the process of becoming a successful home health nurse. |
- Washington, DC, Virginia, and Maryland
- 30 home care nurses
- Open-ended interviews with comparative analysis
|
- Successful home care nurses go through 3 stages.
The stages are: Dependence, Moderate Dependence and Autonomy.
- Reasons nurses may temporarily fall back to stage 2 are:
- - Poor physician-nurse relationships
- - Reimbursement factors or payers not supporting visits or supplies
- - Unfamiliar clinical situations
- - Patients non-adherent to recommendations
|
Neal, 1999a |
Describe the practice of home care nurses. |
- Washington, DC, Virginia, and Maryland
- 30 home care nurses
- Open-ended interviews with comparative analysis
|
- Nurses defined their practices as professional autonomy, taking broader view,
& finishing the story
- Nurses' skills should be organization, good communication & adaptable
- Autonomy:
- walking a fine line, linking, and discovering
- Broader view:
- caring for everything that affects the patient, nursing holistically
- Finishing the Story:
- starting over (with education), preparing (patient to be independent), letting go
|
Neal, 1999b |
Top of Page |
Determine case load size for home care nurses |
- National
- Survey 136 nurses
- All nurses worked in Medicare certified home health care agency with at least
1 year experience
|
- Caseload range =
- 9-36 seniors,
- Mean caseload = 16 seniors
- Home visits/day range = 3 - 9
- Mean home visits/ day = 5.6
- Medicare repeat visit = 45 minutes
- New admission visit = 2 hours
- Shorter visits were monthly activities, such as changing Foley catheter
- Nurses felt acuity levels, new admissions, office activities, etc. were influences
in number of visits / day
|
Rice, 1997 |
Determine home care nurses' daily activities |
- Southeastern state
- 24 home health agencies
- 143 nurses reported on over 1400 clinical days
- Nurses recorded time & activities for 10 consecutive days
|
- 29% of time in direct care
- 71% of time with indirect care
- Agency type did not vary direct care time significantly
|
Shuster & Cloonan, 1989 |
Determine job satisfaction components among home care & hospital nurses |
- Southeastern state
- 24 home care agencies & hospitals
- 129 nurses
- mail survey
- Job Satisfaction Scales with Likert response set
- Self reported time activities for 10 days
|
- Both nurse groups generally satisfied & enjoyed job
- Home care nurses had higher job
satisfaction & enjoyment
- Hospital nurses had higher satisfaction
with time to do work
- Nurses who spent more of their day with direct client contact reported higher
job satisfaction & enjoyment.
|
Shuster, 1992 |
Describe experiences of providing care to older adults in both acute care
and nursing homes |
- Philadelphia Metropolitan Area
- 15 nurses
- Focus groups
|
- Rewarding moments occurred when RNs made interpersonal connections
with patients helping clinically or accepting death
- In nursing homes emphasis was on knowing the resident
over time, facilitating well being, taking into account the seniors' previous life events
& rehabilitation potential.
|
Tagliareni, Mengel, & Sherman, 1993 |
Explore perceptions of nursing home & home care nurse experiences |
- Florida
- 5 RNS providing follow-up home care
to discharged nursing home seniors
- 1 year of interviews
|
- Moments of excellence described, common themes identified:
- 1-Professional transformation
- 2- Making a Difference
- 3- Mutual Relationships
- 4- Feeling rewarded
|
Turkel, et al., 1999 |