Quality of work life and turnover intention in primary healthcare organisations : a cross-sectional study of registered nurses in Saudi Arabia

Purpose: The purpose of this study was to improve the retention of primary healthcare (PHC) nurses through exploring and assessing their quality of work life (QWL) and turnover intention. Design and methods: A cross-sectional survey design was used in this study. Data were collected using a questionnaire comprising four sections (Brooks’ survey of Quality of Nursing Work Life [QNWL], Anticipated Turnover Intention, open-ended questions and demographic characteristics). A convenience sample was recruited from 143 PHC centres in Jazan, Saudi Arabia. A response rate of 87% (n = 508/585) was achieved. The SPSS v17 for Windows and NVivo 8 were used for analysis purposes. Procedures and tests used in this study to analyse the quantitative data were descriptive statistics, t-test, ANOVA, General Linear Model (GLM) univariate analysis, standard multiple regression, and hierarchical multiple regression. Qualitative data obtained from responses to the open-ended questions were analysed using the NVivo 8. Findings: Quantitative findings suggested that PHC nurses were dissatisfied with their work life. Respondents’ scores ranged between 45 and 218 (mean = 139.45), which is lower than the average total score on Brooks’ Survey (147). Major influencing factors were classified under four dimensions. First, work life/home life factors: unsuitable working hours, lack of facilities for nurses, inability to balance work with family needs and inadequacy of vacations’ policy. Second, work design factors: high workload, insufficient workforce numbers, lack of autonomy and undertaking many non-nursing tasks. Third, work context factors: management practices, lack of development opportunities, and inappropriate working environment in terms of the level of security, patient care supplies and unavailability of recreation room. Finally, work world factors: negative public image of nursing, and inadequate payment. More positively, nurses were notably satisfied with their co-workers. Conversely, 40.4% (n = 205) of the respondents indicated that they intended to leave their current employment. The relationships between QWL and demographic variables of gender, age, marital status, dependent children, dependent adults, nationality, ethnicity, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to medium effect size of the variation in QWL scores. Using the GLM univariate analysis, education level was also significantly related to the QWL (p < .05). The relationships between turnover intention and demographic variables including gender, age, marital status, dependent children, education level, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to moderate effect size of the variation in the turnover intention scores. Using the GLM univariate analysis, the dependent adults’ variable was also significantly related to turnover intention (p < .05). Turnover intention was significantly related to QWL. Using standard multiple regression, 26% of the variance in turnover intention was explained by the QWL F (4,491), 43.71, p < .001, with R² = .263. Further analysis using hierarchical multiple regression found that the total variance explained by the model as a whole (demographics and QWL) was 32.1%, F (17.433) = 12.04, p < .001. QWL explained an additional 19% of the variance in turnover intention, after controlling for demographic variables, R squared change =.19, F change (4, 433) = 30.190, p < .001. The work context variable makes the strongest unique contribution (-.387) to explain the turnover intention, followed by the work design dimension (-.112). The qualitative findings reaffirmed the quantitative findings in terms of QWL and turnover intention. However, the home life/work life and work world dimensions were of great important to both QWL and turnover intention. The qualitative findings revealed a number of new factors that were not included in the survey questionnaire. These included being away from family, lack of family support, social and cultural aspects, accommodation facilities, transportation, building and infrastructure of PHC, nature of work, job instability, privacy at work, patients and community, and distance between home and workplace. Conclusion: Creating and maintaining a healthy work life for PHC nurses is very important to improve their work satisfaction, reduce turnover, enhance productivity and improve nursing care outcomes. Improving these factors could lead to a higher QWL and increase retention rates and therefore reinforcing the stabilisation of the nursing workforce. Significance of the research: Many countries are examining strategies to attract and retain the health care workforce, particularly nurses. This study identified factors that influence the QWL of PHC nurses as well as their turnover intention. It also determined the significant relationship between QWL and turnover intention. In addition, the present study tested Brooks’ survey of QNWL on PHC nurses for the first time. The qualitative findings of this study revealed a number of new variables regarding QWL and turnover intention of PHC nurses. These variables could be used to improve current survey instruments or to develop new research surveys. The study findings could be also used to develop and appropriately implement plans to improve QWL. This may help to enhance the home and work environments of PHC nurses, improve individual and organisational performance, and increase nurses’ commitment. This study contributes to the existing body of research knowledge by presenting new data and findings from a different country and healthcare system. It is the first of its kind in Saudi Arabia, especially in the field of PHC. It has examined the relationship between QWL and turnover intention of PHC nurses for the first time using nursing instruments. The study also offers a fresh explanation (new framework) of the relationship between QWL and turnover intention among PHC nurses, which could be used or tested by researchers in other settings. Implications for further research: Review of the extant literature reveals little in-depth research on the PHC workforce, especially in terms of QWL and organisational turnover in developing countries. Further research is required to develop a QWL tool for PHC nurses, taking into consideration the findings of the current study along with the local culture. Moreover, the revised theoretical framework of the current study could be tested in further research in other regions, countries or healthcare systems in order to identify its ability to predict the level of PHC nurses’ QWL and their intention to leave. There is a need to conduct longitudinal research on PHC organisations to gain an in-depth understanding of the determents of and changes in QWL and turnover intention of PHC nurses at various points of time. An intervention study is required to improve QWL and retention among PHC nurses using the findings of the current study. This would help to assess the impact of such strategies on reducing turnover of PHC nurses. Focusing on the location of the current study, it would be valuable to conduct another study in five years’ time to examine the percentage of actual turnover among PHC nurses compared with the reported turnover intention in the current study. Further in-depth research would also be useful to assess the impact of the local culture on the perception of expatriate nurses towards their QWL and their turnover intention. A comparative study is required between PHC centres and hospitals as well as the public and private health sector agencies in terms of QWL and turnover intention of nursing personnel. Findings may differ from sector to sector according to variations in health systems, working environments and the case mix of patients.

Visual support for work assignment in process-aware information systems : framework formalisation and implementation

Process-aware information systems, ranging from generic workflow systems to dedicated enterprise information systems, use work-lists to offer so-called work items to users. In real scenarios, users can be confronted with a very large number of work items that stem from multiple cases of different processes. In this jungle of work items, users may find it hard to choose the right item to work on next. The system cannot autonomously decide which is the right work item, since the decision is also dependent on conditions that are somehow outside the system. For instance, what is “best” for an organisation should be mediated with what is “best” for its employees. Current work-list handlers show work items as a simple sorted list and therefore do not provide much decision support for choosing the right work item. Since the work-list handler is the dominant interface between the system and its users, it is worthwhile to provide an intuitive graphical interface that uses contextual information about work items and users to provide suggestions about prioritisation of work items. This paper uses the so-called map metaphor to visualise work items and resources (e.g., users) in a sophisticated manner. Moreover, based on distance notions, the work-list handler can suggest the next work item by considering different perspectives. For example, urgent work items of a type that suits the user may be highlighted. The underlying map and distance notions may be of a geographical nature (e.g., a map of a city or office building), but may also be based on process designs, organisational structures, social networks, due dates, calendars, etc. The framework proposed in this paper is generic and can be applied to any process-aware information system. Moreover, in order to show its practical feasibility, the paper discusses a full-fledged implementation developed in the context of the open-source workflow environment YAWL, together with two real examples stemming from two very different scenarios. The results of an initial usability evaluation of the implementation are also presented, which provide a first indication of the validity of the approach.

Development and feasibility of a smartphone, ECG and GPS based system for remotely monitoring exercise in cardiac rehabilitation

Background Despite its efficacy and cost-effectiveness, exercise-based cardiac rehabilitation is undertaken by less than one-third of clinically eligible cardiac patients in every country for which data is available. Reasons for non-participation include the unavailability of hospital-based rehabilitation programs, or excessive travel time and distance. For this reason, there have been calls for the development of more flexible alternatives. Methodology and Principal Findings We developed a system to enable walking-based cardiac rehabilitation in which the patient's single-lead ECG, heart rate, GPS-based speed and location are transmitted by a programmed smartphone to a secure server for real-time monitoring by a qualified exercise scientist. The feasibility of this approach was evaluated in 134 remotely-monitored exercise assessment and exercise sessions in cardiac patients unable to undertake hospital-based rehabilitation. Completion rates, rates of technical problems, detection of ECG changes, pre- and post-intervention six minute walk test (6 MWT), cardiac depression and Quality of Life (QOL) were key measures. The system was rated as easy and quick to use. It allowed participants to complete six weeks of exercise-based rehabilitation near their homes, worksites, or when travelling. The majority of sessions were completed without any technical problems, although periodic signal loss in areas of poor coverage was an occasional limitation. Several exercise and post-exercise ECG changes were detected. Participants showed improvements comparable to those reported for hospital-based programs, walking significantly further on the post-intervention 6 MWT, 637 m (95% CI: 565–726), than on the pre-test, 524 m (95% CI: 420–655), and reporting significantly reduced levels of cardiac depression and significantly improved physical health-related QOL. Conclusions and Significance The system provided a feasible and very flexible alternative form of supervised cardiac rehabilitation for those unable to access hospital-based programs, with the potential to address a well-recognised deficiency in health care provision in many countries. Future research should assess its longer-term efficacy, cost-effectiveness and safety in larger samples representing the spectrum of cardiac morbidity and severity.

An expanded critical incident approach for exploring information use and learning

Critical incidents offer a focus for exploratory research about human experiences, including information use and information literacy learning. This paper describes how critical incidents underpinned research about international students’ use of online information resources at two Australian universities. It outlines the development and application of an expanded critical incident approach (ECIA), explaining how ECIA built upon critical incident technique (CIT) and incorporated information literacy theory. It discusses points of expansion (differences) between CIT and ECIA. While CIT initially proved useful in structuring the research, the pilot study revealed methodological limitations. ECIA allowed more nuanced data analysis and the integration of reflection. The study produced a multifaceted word picture of international students’ experience of using online information resources to learn, and a set of critical findings about their information literacy learning needs. ECIA offers a fresh approach for researching information use, information experience, evidence-based practice, information literacy and informed learning.

The future of Australian e-learning : it’s all about access

This article clarifies the interdependence between high-speed broadband and e-Learning. It does this by identifying the importance of the internet for Australia’s education future and the importance of education for the future of the internet. It concludes by confirming the role the NBN will play as an enabler of both; and the need to ensure access for all to appropriate skills, as well as to services.

Learning landscapes 2.0 : warning - assembly required

Twenty first century learners operate in organic, immersive environments. A pedagogy of student-centred learning is not a recipe for rooms. A contemporary learning environment is like a landscape that grows, morphs, and responds to the pressures of the context and micro-culture. There is no single adaptable solution, nor a suite of off-the-shelf answers; propositions must be customisable and infinitely variable. They must be indeterminate and changeable; based on the creation of learning places, not restrictive or constraining spaces. A sustainable solution will be un-fixed, responsive to the life cycle of the components and materials, able to be manipulated by the users; it will create and construct its own history. Learning occurs as formal education with situational knowledge structures, but also as informal learning, active learning, blended learning social learning, incidental learning, and unintended learning. These are not spatial concepts but socio-cultural patterns of discovery. Individual learning requirements must run free and need to be accommodated as the learner sees fit. The spatial solution must accommodate and enable a full array of learning situations. It is a system not an object. Three major components: 1. The determinate landscape: in-situ concrete 'plate' that is permanent. It predates the other components of the system and remains as a remnant/imprint/fossil after the other components of the system have been relocated. It is a functional learning landscape in its own right; enabling a variety of experiences and activities. 2. The indeterminate landscape: a kit of pre-fabricated 2-D panels assembled in a unique manner at each site to suit the client and context. Manufactured to the principles of design-for-disassembly. A symbiotic barnacle like system that attaches itself to the existing infrastructure through the determinate landscape which acts as a fast growth rhizome. A carapace of protective panels, infinitely variable to create enclosed, semi-enclosed, and open learning places. 3. The stations: pre-fabricated packages of highly-serviced space connected through the determinate landscape. Four main types of stations; wet-room learning centres, dry-room learning centres, ablutions, and low-impact building services. Entirely customised at the factory and delivered to site. The stations can be retro-fitted to suit a new context during relocation. Principles of design for disassembly: material principles • use recycled and recyclable materials • minimise the number of types of materials • no toxic materials • use lightweight materials • avoid secondary finishes • provide identification of material types component principles • minimise/standardise the number of types of components • use mechanical not chemical connections • design for use of common tools and equipment • provide easy access to all components • make component size to suite means of handling • provide built in means of handling • design to realistic tolerances • use a minimum number of connectors and a minimum number of types system principles • design for durability and repeated use • use prefabrication and mass production • provide spare components on site • sustain all assembly and material information

Learning beyond books : strategies for ambient media to improve libraries and collaboration spaces as interfaces for social learning

With the advent of digital media and online information resources, public libraries as physical destinations for information access are being increasingly challenged. As a response, many libraries follow the trend of removing bookshelves in order to provide more floorspace for social interaction and collaboration. Such spaces follow a Commons 2.0 model: they are designed to support collaborative work and social learning. The acquisition of skills and knowledge is facilitated as a result of being surrounded by and interacting with a community of likeminded others. Based on the results of a case study on a Commons 2.0 library space, this paper describes several issues of collaboration and social learning in public library settings. Acknowledging the significance of the architectural characteristics of the physical space, we discuss opportunities for ambient media to better reflect the social attributes of the library as a place; i.e. amplify the sense of other co-present library visitors and provide opportunities for shared encounters and conversations, which would remain invisible otherwise. We present the design of a user check-in system for improving the library as a physical destination for social learning, sharing, and inspiration for and by the community.

The adoption of e-learning 2.0 in higher education by teachers and students : an investigation using mixed methods approach

This paper describes an approach to investigate the adoption of Web 2.0 in the classroom using a mixed methods study. By using a combination of qualitative or quantitative data collection and analysis techniques, we attempt to synergize the results and provide a more valid understanding of Web 2.0 adoption for learning by both teachers and students. This approach is expected to yield a better holistic view on the adoption issues associated with the e-learning 2.0 concept in current higher education as opposed to single method studies done previously. This paper also presents some early findings of e-learning 2.0 adoption using this research method

Social media and Web 2.0 : teacher-librarians, risk and inequity

This paper reports research into teacher-­‐librarians’ perceptions of using social media and Web 2.0 in teaching and learning. A pilot study was conducted with teacher-­‐librarians in five government schools and five private schools in southeast Queensland. The findings revealed that there was a strong digital divide between government schools and private schools, with government schools suffering severe restrictions on the use of social media and Web 2.0, leading to an unsophisticated use of these technologies. It is argued that internet ‘over-­‐ blocking’ may lead to government school students not being empowered to manage risks in an open internet environment. Furthermore, their use of information for academic and recreational learning may be compromised. This has implications particularly for low socioeconomic students, leading to further inequity in the process and outcomes of Australian education.

Teaching and learning family and consumer sciences through K-W-L charts

While much of the control and many of the activities found in today’s classrooms have been placed in the hands of the learners and learning has become inquiry-based, there remains a need for teachers to use teaching tools that would facilitate this student-centered teaching process. This article identifies the K-W-L Chart as one such tool and follows a case study of four Kuwaiti ‘Family and Consumer Sciences’ teaching / learning events to evaluate their ability to enhance the learning outcomes of eight students. The research was designed from a qualitative, multi-tiered design approach and was assessed through a constant comparative method of data analysis of interview responses, classroom observations and worksheet-assessments. The results showed that the use of K-W-L Charts influenced the teachers and learners toward a more inquiry-based approach and facilitated a more student-centered and collaborative learning environment, raising the level of interest and the amount of personal input given by the students.

Embedding graphic organisers in the teaching and learning of family and consumer sciences (home economics) in Kuwait

Educational reforms currently being enacted in Kuwaiti Family and Consumer Sciences (FCS) in response to contemporary demands for increased student-centred teaching and learning are challenging for FCS teachers due to their limited experience with student-centred learning tools such as Graphic Organisers (GOs). To adopt these reforms, Kuwaiti teachers require a better understanding of and competency in promoting cognitive learning processes that will maximise student-centred learning approaches. This study followed the experiences of four Grade 6 FCS Kuwaiti teachers as they undertook a Professional Development (PD) program specifically designed to advance their understanding of the use of GOs and then as they implemented what they had learned in their Grade 6 FCS classroom. The PD program developed for this study was informed by Nasseh.s competency PD model as well as Piaget and Ausubel.s cognitive theories. This model enabled an assessment and evaluation of the development of the teachers. competencies as an outcome of the PD program in terms of the adoption of GOs, in particular, and their capacity to use GOs to engage students in personalised, in-depth, learning through critical thinking and understanding. The research revealed that the PD program was influential in reforming the teachers. learning, understanding of and competency in, cognitive and visual theories of learning, so that they facilitated student-centred teaching and learning processes that enabled students to adopt and adapt GOs in constructivist learning. The implementation of five GOs - Flow Chart, Concept Maps, K-W-L Chart, Fishbone Diagram and Venn Diagram - as learning tools in classrooms was investigated to find if changes in pedagogical approach for supporting conceptual learning through cognitive information processing would reduce the cognitive work load of students and produce better learning approaches. The study as evidenced by the participant teachers. responses and classroom observations, showed a marked increase in student interest, participation, critical thought, problem solving skills, as a result of using GOs, compared to using traditional teaching and learning methods. A theoretical model was developed from the study based on the premise that teachers. knowledge of the subject, pedagogy and student learning precede the implementation of student-centred learning reform, that it plays an important role in the implementation of student-centred learning and that it brings about a change in teaching practice. The model affirmed that observed change in teaching-practice included aspects of teachers. beliefs, as well as confidence and effect on workplace and on student learning, including engagement, understanding, critical thinking and problem solving. The model assumed that change in teaching practice is inseparable from teachers. lifelong PD needs related to knowledge, understanding, skills and competency. These findings produced a set of preliminary guidelines for establishing student-centred constructivist strategies in Kuwaiti education while retaining Kuwait.s cultural uniqueness.

'Information in context' : co-designing workplace structures and systems for organizational learning

With the aim of advancing professional practice through better understanding how to create workplace contexts that cultivate individual and collective learning through situated 'information in context' experiences, this paper presents insights gained from three North American collaborative design (co-design) implementations. In the current project at the Auraria Library in Denver, Colorado, USA, participants use collaborative information practices to redesign face-to-face and technology-enabled communication, decision making, and planning systems. Design processes are described and results-to-date described, within an appreciative framework which values information sharing and enables knowledge creation through shared leadership.

The embodied hybrid space : designing social and digital interventions to facilitate connected learning in coworking spaces

This thesis developed and evaluated strategies for social and ubiquitous computing designs that can enhance connected learning and networking opportunities for users in coworking spaces. Based on a social and a technical design intervention deployed at the State Library of Queensland, the research findings illustrate the potential of combining social, spatial and digital affordances in order to nourish peer-to-peer learning, creativity, inspiration, and innovation. The study proposes a hybrid notion of placemaking as a new way of thinking about the design of coworking and interactive learning spaces.

Exploring the conditions to support assessment for more equitable learning outcomes

NAPLAN RESULTS HAVE gained socio-political prominence and have been used as indicators of educational outcomes for all students, including Indigenous students. Despite the promise of open and in-depth access to NAPLAN data as a vehicle for intervention, we argue that the use of NAPLAN data as a basis for teachers and schools to reduce variance in learning outcomes is insufficient. NAPLAN tests are designed to show statistical variance at the level of the school and the individual, yet do not factor in the sociocultural and cognitive conditions Indigenous students’ experience when taking the tests. We contend that further understanding of these influences may help teachers understand how to develop their classroom practices to secure better numeracy and literacy outcomes for all students. Empirical research findings demonstrate how teachers can develop their classroom practices from an understanding of the extraneous cognitive load imposed by test taking. We have analysed Indigenous students’ experience of solving mathematical test problems to discover evidence of extraneous cognitive load. We have also explored conditions that are more supportive of learning derived from a classroom intervention which provides an alternative way to both assess and build learning for Indigenous students. We conclude that conditions to support assessment for more equitable learning outcomes require a reduction in cognitive load for Indigenous students while maintaining a high level of expectation and participation in problem solving.

Reconstructing places and spaces in blended work integrated learning

This paper considers the emergence and ongoing development of an embedded, studentnegotiated work placement model of Work Integrated Learning (WIL) in the engineering and built environment disciplines at an Australian metropolitan university. The characteristics of the model and a continuous improvement strategy are provided. The model is characterised by large student cohorts independently sourcing and negotiating relevant work placements and completing at least one, mandatory credit-bearing WIL unit. Through ongoing analyses and evaluation of the model more experiential and collaborative learning approaches have been adopted. This has included the creation of blended learning spaces using technology. The paper focuses on the five year journey travelled by the teaching team as they embarked on ways to improve curriculum, pedagogy, administrative processes and assessment - effectively relocating much of their interaction with students online. The insights derived from this rich, single case study should be of interest to others considering alternative ways of responding to increasing student enrolments in WIL and the impact of blended learning in this context.