Journal Club: Factors influencing nurses’ intentions to leave adult critical care

Journal Club Article: Khan, N., Jackson, D., Stayt, L., & Walthall, H. (2018). Factors influencing nurses’ intentions to leave adult critical care settingsNursing in critical care.

 

Background:

“Nurse retention is a global problem across all specialities but is exacerbated in critical care areas where elevated nurse–patient ratios and the use of advance technologies require greater numbers of highly educated and specialized nurses impacting costs and quality of patient care.”

Factors identified in previous research such as working conditions, burnout syndrome, organisational climate, staffing levels, empowerment, personal health and work pressure.

Relevance to practice:

“The shortage of critical care nurses is currently a global issue impacting costs and quality of patient care.”

Method:

A systematic mixed-method literature review.

Findings:

3 themes identified were quality of the work environment, nature of working relationships and traumatic/stressful workplace experiences.

  1. Quality of the work environment

Empowerment and professional development opportunities. Having enough time to recover from night shifts and the impact of inflexible rotations on work–life balance.

2. Nature of working relationships

When conflict occurs with families and relatives. Poor relationships between nurse to manager and nurse to physician, especially not being involved in the decision making process.

3. Traumatic/stressful workplace experiences

Futility in the level of care being provided, caring for the dying patient and decisions to forego life‐sustaining treatments.

Conclusion:

High nursing turnover is a global issue and nurse leaders in critical care areas need to take these findings into consideration when developing strategies to improve turnover and support strategies.

Keywords: Burnout; Culture: Nurse Retention; Stress; Teamwork.

Additional Resource: Best Nursing Degree from Shanna Shafer (BSN) regarding shortage of nurses and also nurse faculty in the US, and reshaping the future of nursing and nurse education.

 

Developing Person-Centred Care: Addressing Contextual Challenges Through Practice Development

Journal Club Article: McCormack, B., Dewing, J., & McCance, T. (2011). Developing person-centred care: addressing contextual challenges through practice development. OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 3.

This article aims to identify and discuss issues to consider in the development of person-centred care. As healthcare moves into service deliver for the individual then the focus of person-centred care will become increasingly important in training nurses of the future and current ones to deliver care on an individual level.

What is Person-Centred Care?

McCormack et al. (2011) define person-centred care as “an approach to practice that is established through the formation and fostering of therapeutic relationships between all care providers, patients, and others significant to them.”

How to Deliver Person-Centred Care?

“Developing person-centred care is not a one-time event; rather it requires a sustained commitment from organisations to the ongoing facilitation of developments, a commitment both in clinical teams and across organizations.”

  • Practice context,
  • Workplace culture,
  • Learning culture,
  • Physical environment.

The authors suggest in healthcare there are ‘person-centred moments’, at the individual level with ad hoc experiences of person-centredness occurring but not at a sustained and meaningful level.

“…it must further be considered how person-centred moments can be transformed into ‘person-centred cultures’ of practice…”

Culture

“The international drive (particularly over the past 15 years) to ‘modernise’ healthcare systems has led to a significant focus on the impact of culture on the clinical effectiveness of staff and service-user experiences of health and social care. Cultures are also characterised by shared values, team effectiveness, a commitment to continuous learning and improvement, and transformational leadership.”

“The key goal in the development of a positive learning culture is to recognize and overcome individual, group, and organizational barriers in order to move towards an effective culture and to overcome the features of workplaces that nurture hierarchical management and horizontal violence (Brown & McCormack, 2011).”

Person-centred care must underpin culture of teams and organisations. This requires empowerment and emancipatory practice to occur throughout the organisation. The traditional hierarchy and autocratic practice will need to be addressed to create an organisational change.

Contextual Factors and the Development of Person-Centred Care

The authors ask us to consider the shifts when it all worked, it clicked into place and the team worked. Admission, discharges, post ops, deterioration, family updates, all staff were well supported and you finished with a buzz and achievement that you expected nursing to on a regular basis. Positive thoughts here, hopefully you can recollect one shift in recent times (even you UK NHS staff).

Why can’t it be like this all the time?

This is the question we need to ask and reflect on. What was it about this shift that made it all work and how can we replicate this. So for person-centred care the focus is not just on the client but also the healthcare team. If they cannot perform to their best, then the service will not excel.

The authors recognise and “acknowledge that we do not work in a state of utopia, and that everyday practice is challenging, often stressful, sometimes chaotic, and largely unpredictable”. So some days will just be awful, sad and depressing but if we can make them fewer then surely staff satisfaction, teamwork, burnout and other stressors could be reduced.

Education focus: Active Learning 

A learning culture is a culture in which nurses view their work as exciting and revitalising, offering them the prospect for both personal and professional growth.

“Active learning draws on many activities including multiple intelligence’s, critical reflection, learning from self, and also conversations and shared experiences with others, all of which enable facilitation of change in the workplace. Central to active learning is both the translation of learning into practice so that the practitioner’s own practice is experienced differently and the enabling or facilitating of active learning with others. Active learning takes knowledge, in its many forms, and looks at how it can become (emotionally) meaningful for individuals and teams.”

How do I move towards this way of nursing?

“Developing Person-Centred Care Through Emancipatory Practice Development Practice which emphasises the central place of learning through everyday practice, what we have come to describe as ‘active learning.”

The Environment

“the physical environment needs to work in concert with the cultural values in care teams and the ways of working that enable person-centredness to be realised. In this respect, two aspects of the physical environment need to be attended to, namely, the built environment and the aesthetic environment. Most hospitals and healthcare facilities have been designed and built with ‘clinical efficiency,’ and not personcentredness, in mind.”

Summary

In the development of a framework for person-centred nursing, McCormack and McCance (2010) identified a range of attributes of practice contexts that impacted on the operationalisation of person-centred care. Of particular significance were workplace culture, learning culture, and the physical environment. The health organisation needs to provide conditions that are necessary for staff to feel empowered.

Keywords: person-centred; emancipation; culture; active learning; transformational leadership.

Reference

McCormack, B., Dewing, J., & McCance, T. (2011). Developing person-centred care: addressing contextual challenges through practice development. OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 3.

McCormack, B., Manley, K, & Garbett, R. (2008). Practice Development in Nursing. [sample here]