Economic fluctuations and productivity in the Malaysian construction sector

Growth in productivity is the key determinant of the long-term health and prosperity of an economy. The construction industry being one of major strategic importance, its productivity performance has a significant effect on national economic growth. The relationship between construction output and economy has received intensive studies, but there is lack of empirical study on the relationship between construction productivity and economic fluctuations. Fluctuations in construction output are endemic in the industry. In part they are caused by the boom and slump of the economy as a whole and in part by the nature of the construction product. This research aims to uncover how the productivity of construction sector is influenced in the course of economic fluctuations in Malaysia. Malaysia has adopted three economic policies – New Economic Policy (1971-1990), National Development Policy (1991-2000) and the National Vision Policy (2001-2010) since gaining independence in 1959. The Privatisation Master Plan was introduced in 1991. Operating within this historical context, the Malaysian construction sector has experienced four business cycles since 1960. A mixed-method design approach is adopted in this study. Quantitative analysis was conducted on the published official statistics of the construction industry and the overall economy in Malaysia between 1970 and 2009. Qualitative study involved interviews with a purposive sample of 21 industrial participants. This study identified a 32-year long building cycle appears in 1975-2006. It is superimposed with three shorter construction business cycles in 1975-1987, 1987-1999 and 1999-2006. The correlations of Construction labour productivity (CLP) and GDP per capita are statistically significant for the 1975-2006 building cycle, 1987-1999 and 1999-2006 construction business cycles. It was not significant in 1975-1987 construction business cycles. The Construction Industry Surveys/Census over the period from 1996 to 2007 show that the average growth rate of total output per employee expanded but the added value per employee contracted which imply high cost of bought-in materials and services and inefficient usage of purchases. The construction labour productivity is peaked at 2004 although there is contraction of construction sector in 2004. The residential subsector performed relatively better than the other sub-sectors in most of the productivity indicators. Improvements are found in output per employee, value added per employee, labour competitiveness and capital investment but declines are recorded in value added content and capital productivity. The civil engineering construction is most productive in the labour productivity nevertheless relatively poorer in the capital productivity. The labour cost is more competitive in the larger size establishment. The added value per labour cost is higher in larger sized establishment attributed to efficient in utilization of capital. The interview with the industrial participant reveals that the productivity of the construction sector is influenced by the economic environment, the construction methods, contract arrangement, payment chain and regulatory policies. The fluctuations of construction demand have caused companies switched to defensive strategy during the economic downturn and to ensure short-term survival than to make a profit for the long-term survival and growth. It leads the company to take drastic measures to curb expenses, downsizing, employ contract employment, diversification and venture overseas market. There is no empirical evidence supports downsizing as a necessary step in a process of reviving productivity. The productivity does not correlate with size of firm. A relatively smaller and focused firm is more productive than the larger and diversified organisation. However diversified company experienced less fluctuation in both labour and capital productivity. In order to improve the productivity of the construction sector, it is necessary to remove the negatives and flaws from past practices. The recommended measures include long-term strategic planning and coordinated approaches of government agencies in planning of infrastructure development and to provide regulatory environments which encourage competition and facilitate productivity improvement.

Negative change and job outcomes : the impact of subjective fit in public sector health care organization

There is an ongoing level of organizational-wide change (such as empowerment and downsizing) occurring within the Australian health care sector. However, there is a paucity of empirical evidence on how public and nonprofit sector nurses cope with these organizational-wide change initiatives and their consequences on individual and work outcomes. This will be the primary aim of the current paper. To this end, a path model is developed base on an integration of existing theoretical perspectives on occupational stress, change management, and person-organizational fit. Data were collected from 252 public and not-for-profit sector nurses. The path analysis suggests that public and nonprofit nurses experience positive and negative change initiatives. Negative change initiatives resulted in an increase in the level of administrative-related stressors. Nurses with more congruent values report less experience with administrative stressors. As nurses experienced more administrative stressors, they tend to report more job dissatisfaction. Nurses whose values were more congruent during organizational change reported higher level of psychological wellbeing. Nurses who were had higher level of psychological wellbeing were found to have higher job satisfaction, which subsequently led to a higher level of organizational commitment.

Public sector change, person-organization fit, and work attitudes : a mediation model

Organizational change is a typical phenomenon within public sector agencies in OECD countries. An increasing number of studies in the literature examine the implementation of change and its resulting impact on the work attitudes of public sector employees; however, little is known about the extent to which change management processes impact on employees’ work attitudes. This study aims to address this issue by developing a path model underpinned by change management and public service motivation literature. The path model was tested on a sample of 308 managerial and non-managerial public sector employees from the U.S. The results provide further empirical evidence on the types of change initiatives on nursing work and change management processes being implemented. Public sector agencies in the sample implemented a variety of change initiatives such as downsizing, delayering and empowerment. Employees reported two change management processes: the provision of change-related information and participation in change decision making. While the results indicate that change produces change-induced stressors, change information tends to reduce stressors and, subsequently, role stress. The results also indicate that change management processes are associated with higher levels of public service motivation, which is in turn connected to higher levels of person–organization fit. Person–organization fit was found to partially mediate the relationship between public service motivation and job satisfaction in the context of change.

Ways of Explaining Workplace Bullying: A Review of Enabling, Motivating, and Precipitating Structures and Processes in the Work Environment

This paper summarizes literature explaining workplace bullying and focuses on organisational antecedents of bullying. In order to better understand the logic behind bullying, a model discussing different types of explanations is put forward. Thus, explanations for and factors associated with bullying are classified into three groups, i.e. enabling structures or necessary antecedents (e.g. perceived power imbalances, low perceived costs, and dissatisfaction and frustration), motivating structures or incentives (e.g. internal competition, reward systems, and expected benefits), and precipitating processes or triggering circumstances (e.g. downsizing and restructuring, organisational changes, changes in the composition of the workgroup). The paper concludes that bullying is often an interaction between structures and processes from all three groupings.

Constructing Stability in Software Product Development during Organizational Restructurings

We all have fresh in our memory what happened to the IT sector only a few years ago when the IT-bubble burst. The upswing of productivity in this sector slowed down, investors lost large investments, many found themselves looking for a new job, and countless dreams fell apart. Product developers in the IT sector have experienced a large number of organizational restructurings since the IT boom, including rapid growth, downsizing processes, and structural reforms. Organizational restructurings seem to be a complex and continuous phenomenon people in this sector have to deal with. How do software product developers retrospectively construct their work in relation to organizational restructurings? How do organizational restructurings bring about specific social processes in product development? This working paper focuses on these questions. The overall aim is to develop an understanding of how software product developers construct their work during organizational restructurings. The theoretical frame of reference is based on a social constructionist approach and discourse analysis. This approach offers more or less radical and critical alternatives to mainstream organizational theory. Writings from this perspective attempt to investigate and understand sociocultural processes by which various realities are created. Therefore these studies aim at showing how people participate in constituting the social world (Gergen & Thatchenkery, 1996); knowledge of the world is seen to be constructed between people in daily interaction, in which language plays a central role. This means that interaction, especially the ways of talking and writing about product development during organizational restructurings, become the target of concern. This study consists of 25 in-depth interviews following a pilot study based on 57 semi-structured interviews. In this working paper I analyze 9 in-depth interviews. The interviews were conducted in eight IT firms. The analysis explores how discourses are constructed and function, as well as the consequences that follow from different discourses. The analysis shows that even though the product developers have experienced many organizational restructurings, some of which have been far-reaching, their accounts build strongly on a stability discourse. According to this discourse product development is, perhaps surprisingly, not influenced to a great extent by organizational restructurings. This does not mean that product development is static. According to the social constructionist approach, product development is constantly being reproduced and maintained in ongoing processes. In other words stable effects are also ongoing achievements and these are of particular interest in this study. The product developers maintain rather than change the product development through ongoing processes of construction, even when they experience continuous extensive organizational restructurings. The discourse of stability exists alongside other discourses, some which contradict each other. Together they direct product development and generate meanings. The product developers consequently take an active role in the construction of their work during organizational restructurings. When doing this they also negotiate credible positions for themselves

Uloimmalla rannalla : Luotsi- ja majakkamiesperheet asemayhdyskunnissaan

The subject of the present research is historical lighthouse and maritime pilot stations in Finland. If one thinks of these now-abandoned sites as an empty stage, the dissertation aims to recreate the drama that once played out there. The research comprises three main themes. The first, the family problematic, focuses on the relationship between the family members concerned and the public service positions held, as well as the islands on which these people were stationed. The role of the male actors becomes apparent through an examination of the job descriptions of pilots and lighthouse keepers, but the role of the wives appears more problematic: running a household and the insularity of the community came with their own challenges, and the husbands were away for much of the time. In this context the children emerge as crucial. What was their role in the family of a public official? What were the effects of having to move to the mainland for school? The second theme is the station community. A socioecological examination is undertaken which defines the islands as plots allowing the researcher to study the social behaviours of the isolated communities in question. The development of this theme is based on interpretations of interviews revealing starkly opposed views on the existing neighbourly relations. The premise is that social friction is inevitable among people living within close proximity of each other, and the study proceeds to become an analysis that seeks to uncover the sociocultural strategies designed to control the risks of communal living either by creating distance between neighbours or by enhancing their mutual ties. In connection with this, the question of why some neighbourhoods were open and cooperative while others were restrained and quarrelsome is addressed. Finally, the third main theme discusses the changes in piloting and lighthouse keeping that took place increasingly numerous towards the end of the 20th century. How did individuals react to the central management s technocratic strivings and rationalisations, such as the automation of lighthouses and the intense downsizing of the network of pilot stations? How was piloting, previously very comprehensive work, splintered into specialisations, and how did the entire occupation of lighthouse keeping lose its status before completely disappearing, as the new technology took over?

Metabolome based reaction graphs of M.tuberculosis and M.leprae: A comparative network analysis

Background. Several types of networks, such as transcriptional, metabolic or protein-protein interaction networks of various organisms have been constructed, that have provided a variety of insights into metabolism and regulation. Here, we seek to exploit the reaction-based networks of three organisms for comparative genomics. We use concepts from spectral graph theory to systematically determine how differences in basic metabolism of organisms are reflected at the systems level and in the overall topological structures of their metabolic networks. Methodology/Principal Findings. Metabolome-based reaction networks of Mycobacterium tuberculosis, Mycobacterium leprae and Escherichia coli have been constructed based on the KEGG LIGAND database, followed by graph spectral analysis of the network to identify hubs as well as the sub-clustering of reactions. The shortest and alternate paths in the reaction networks have also been examined. Sub-cluster profiling demonstrates that reactions of the mycolic acid pathway in mycobacteria form a tightly connected sub-cluster. Identification of hubs reveals reactions involving glutamate to be central to mycobacterial metabolism, and pyruvate to be at the centre of the E. coli metabolome. The analysis of shortest paths between reactions has revealed several paths that are shorter than well established pathways. Conclusions. We conclude that severe downsizing of the leprae genome has not significantly altered the global structure of its reaction network but has reduced the total number of alternate paths between its reactions while keeping the shortest paths between them intact. The hubs in the mycobacterial networks that are absent in the human metabolome can be explored as potential drug targets. This work demonstrates the usefulness of constructing metabolome based networks of organisms and the feasibility of their analyses through graph spectral methods. The insights obtained from such studies provide a broad overview of the similarities and differences between organisms, taking comparative genomics studies to a higher dimension.

As adaptações e improvisações no trabalho hospitalar e suas implicações na saúde do trabalhador de enfermagem

O cenário atual das instituições públicas de saúde caracteriza-se pelas peculiaridades do modelo de reestruturação produtiva, em que o enxugamento da máquina pública traduz-se num contexto de precarização das condições de trabalho. Em meio à escassez e inadequação dos recursos materiais e ao déficit de recursos humanos, os trabalhadores de enfermagem vêem-se diante da necessidade de elaborarem adaptações e improvisações de materiais, equipamentos e, até mesmo, de pessoal. Diante desta problemática, selecionou-se como objeto de estudo: a percepção do trabalhador de enfermagem sobre as adaptações e improvisações no trabalho hospitalar e suas implicações na saúde do trabalhador. Apresenta como objetivos: identificar a percepção dos trabalhadores de enfermagem sobre as adaptações e improvisações; descrever as situações que conduzem os trabalhadores de enfermagem à realização desta prática e analisar as implicações das adaptações e improvisações na saúde dos trabalhadores de enfermagem. Pesquisa qualitativa e descritiva, cujo cenário foi um hospital público universitário, localizado na cidade do Rio de Janeiro. Os sujeitos foram vinte trabalhadores das equipes de enfermagem, atuantes nos setores de terapia intensiva e enfermarias cirúrgicas. Os dados foram coletados por meio de entrevista semi-estruturada, no mês de julho do ano de 2009. Procedeu-se à análise temática de conteúdo, a qual propiciou a criação de quatro categorias empíricas: categoria 1: contextos e determinantes das adaptações/improvisações; categoria 2: pré-requisitos para a realização das adaptações/improvisações; categoria 3: aspectos subjetivos vinculados à prática do adaptar/improvisar e categoria 4: a face positiva e a face negativa do adaptar/improvisar as repercussões na saúde do trabalhador. Concluiu-se que as percepções dos trabalhadores de enfermagem sobre a prática do adaptar/improvisar caracteriza-se contraditória ou dialética, com respostas que envolvem o sofrimento e o prazer; a satisfação e a insatisfação; a motivação e a desmotivação, entre outras contradições. Constatou-se que as adaptações e improvisações são elaboradas, predominantemente, para garantir que o cuidado seja prestado, pois diante de um contexto de precarização, a falta de recursos quase que inviabiliza a prestação do cuidado, e esta prática caracteriza-se como uma artimanha ou um ajuste no processo de trabalho o qual assegura que a tarefa seja cumprida. Verificou-se que esta prática tem impactos negativos na saúde, espoliando física e psiquicamente os trabalhadores de enfermagem.

Deep near-infrared spectroscopy of high-redshift galaxies: the physical growth of passive systems

The assembly history of massive galaxies is one of the most important aspects of galaxy formation and evolution. Although we have a broad idea of what physical processes govern the early phases of galaxy evolution, there are still many open questions. In this thesis I demonstrate the crucial role that spectroscopy can play in a physical understanding of galaxy evolution. I present deep near-infrared spectroscopy for a sample of high-redshift galaxies, from which I derive important physical properties and their evolution with cosmic time. I take advantage of the recent arrival of efficient near-infrared detectors to target the rest-frame optical spectra of z > 1 galaxies, from which many physical quantities can be derived. After illustrating the applications of near-infrared deep spectroscopy with a study of star-forming galaxies, I focus on the evolution of massive quiescent systems.

Most of this thesis is based on two samples collected at the W. M. Keck Observatory that represent a significant step forward in the spectroscopic study of z > 1 quiescent galaxies. All previous spectroscopic samples at this redshift were either limited to a few objects, or much shallower in terms of depth. Our first sample is composed of 56 quiescent galaxies at 1 < z < 1.6 collected using the upgraded red arm of the Low Resolution Imaging Spectrometer (LRIS). The second consists of 24 deep spectra of 1.5 < z < 2.5 quiescent objects observed with the Multi-Object Spectrometer For Infra-Red Exploration (MOSFIRE). Together, these spectra span the critical epoch 1 < z < 2.5, where most of the red sequence is formed, and where the sizes of quiescent systems are observed to increase significantly.

We measure stellar velocity dispersions and dynamical masses for the largest number of z > 1 quiescent galaxies to date. By assuming that the velocity dispersion of a massive galaxy does not change throughout its lifetime, as suggested by theoretical studies, we match galaxies in the local universe with their high-redshift progenitors. This allows us to derive the physical growth in mass and size experienced by individual systems, which represents a substantial advance over photometric inferences based on the overall galaxy population. We find a significant physical growth among quiescent galaxies over 0 < z < 2.5 and, by comparing the slope of growth in the mass-size plane dlogR_e/dlogM_∗ with the results of numerical simulations, we can constrain the physical process responsible for the evolution. Our results show that the slope of growth becomes steeper at higher redshifts, yet is broadly consistent with minor mergers being the main process by which individual objects evolve in mass and size.

By fitting stellar population models to the observed spectroscopy and photometry we derive reliable ages and other stellar population properties. We show that the addition of the spectroscopic data helps break the degeneracy between age and dust extinction, and yields significantly more robust results compared to fitting models to the photometry alone. We detect a clear relation between size and age, where larger galaxies are younger. Therefore, over time the average size of the quiescent population will increase because of the contribution of large galaxies recently arrived to the red sequence. This effect, called progenitor bias, is different from the physical size growth discussed above, but represents another contribution to the observed difference between the typical sizes of low- and high-redshift quiescent galaxies. By reconstructing the evolution of the red sequence starting at z ∼ 1.25 and using our stellar population histories to infer the past behavior to z ∼ 2, we demonstrate that progenitor bias accounts for only half of the observed growth of the population. The remaining size evolution must be due to physical growth of individual systems, in agreement with our dynamical study.

Finally, we use the stellar population properties to explore the earliest periods which led to the formation of massive quiescent galaxies. We find tentative evidence for two channels of star formation quenching, which suggests the existence of two independent physical mechanisms. We also detect a mass downsizing, where more massive galaxies form at higher redshift, and then evolve passively. By analyzing in depth the star formation history of the brightest object at z > 2 in our sample, we are able to put constraints on the quenching timescale and on the properties of its progenitor.

A consistent picture emerges from our analyses: massive galaxies form at very early epochs, are quenched on short timescales, and then evolve passively. The evolution is passive in the sense that no new stars are formed, but significant mass and size growth is achieved by accreting smaller, gas-poor systems. At the same time the population of quiescent galaxies grows in number due to the quenching of larger star-forming galaxies. This picture is in agreement with other observational studies, such as measurements of the merger rate and analyses of galaxy evolution at fixed number density.

国有企业管理者裁员决策特征及其对留岗者心理影响的研究

In China, orgnizational change and downsizing are the primary topics studied in I/O psychology and Human Resource Management. Due to the great need in reality, both theorists and practitioners raised the same questions: Does downsizing increase the organizational performance? What is the relationship between organizational downsizing strategies and survivors' psychological reations? Which factors influence managers' downsizing decision-making most? How can managers manage the process successfully? The purpose of this study is trying to answer these questions, and then to establish the downsizing decision-making model of China's SOE (State owned enterprise) managers. The hypothetical model of SOE managers' downsizing decision-making was put forward, based on a tremendous amount of literature on downsizing decision-making, especially on the downsizing decision-making model built by B. Shaw, and also based on the results of the interviews conducted to the SOE managers who have the downsizing decision-making experiences. In order to test and verify the model, 322 SOE managers were investigated by a questionnaire study. And the statistic results supported the hypothetical downsizing decision-making model. Further, 259 survivors (those who are still working in the SOEs) from 7 downsized SOEs and 1 non-downsizing SOE, were also investigated by a questionnaire study. The statistic results also supported the hypothetical downsizing decision-making model. A subsequent case study was performed upon one downsized SOE; and a deliberate focus group interview study within 6 SOE mangers from another downsized SOE was also conducted. Both fundings from the two studies surported the hypothetical model again. Thus, China's SOE managers' downsizing decision-making model was established. This China's SOE managers' downsizing decision-making model suggests the following: Firstly, the characteristics of managers'downsizing decision-making were the center of the model. Those characteristics displayed during the process of the downsizing decision planning, the participation of downsizing decision-making and the communication concerning downsizing events, were influenced by managers' sense of crisis, controlling factors out of the organization and the managing experience within it. Especially, the latter two factors were more important. Secondly, in downsizing decision-making problems, the perceived crisis of China's SOE managers was mainly influenced by the outer factors, esp. the controlling factors from the government or the high authorities, but not by the inner factors including manufacturing management, HRM skills and organizational competition strategies. Thirdly, survivors'psychological reactions (including job satisfaction, job motivation, team working cooperation, etc) were mainly influenced by the characteristics of the managers' downsizing decision-making, at the same time, also by the outer factors (including controlling and social security factors) and the inner factors (including competition strategy and HRM skills). Finally, according to the model and the results from this study, the conclusions were reached in the followings: The stronger the controlling effort upon the SOE managers, the worse the effect displayed during the downsizing process. And in order to improve the effect and quality of downsizing decision-making, SOE managers need a lot of training to ameliorate their competencies such as competition strategies and HRM skills.

Beyond Financialisation? Transformative Strategies for More Sustainable Financial Markets in the European Union

The global financial crisis has led many regulators and lawmakers to a rethinking about current versus optimum financial market structures and activities that include a variety and even radical ideas about delevaraging and downsizing finance. This paper focuses on the flaws and shortcomings of regulatory reforms of finance and on the necessity of and scope for more radical transformative strategies. With 'crisis economics' back, the most developed countries, including the EU member states, are still on the edge of disaster and confronted with systemic risk. Changes in financial regulation adopted in the aftermath of the financial meltdown have not been radical enough to transform the overall system of finance-driven capitalism towards a more sustainable system with a more embedded finance. The paper discusses financialisation in order to understand the development trends in finance over the past decades and examines various theories to describe the typical trends and patterns in financial regulation. By focusing on a limited number of regulatory reforms in the European Union, the limitations of current reforms and the need for additional transformative strategies necessary to overcome the finance-driven accumulation regime are explored. Finally, the regulatory space for such transformative strategies and for taming finance in times of crisis, austerity, and increased public protest potential is analysed.

An analysis of stage performance in automotive turbocharger centrifugal compressors

As the concept of engine downsizing becomes ever more integrated into automotive powertrain development strategies, so too does the pressure on turbocharger manufacturers to deliver improvements in map width and a reduction in the mass flow rate at which compressor surge occurs. A consequence of this development is the increasing importance of recirculating flows, both in the impeller inlet and outlet domains, on stage performance.
The current study seeks to evaluate the impact of the inclusion of impeller inlet recirculation on a meanline centrifugal compressor design tool. Using a combination of extensive test data, single passage CFD predictions, and 1-D analysis it is demonstrated how the addition of inlet recirculation modelling impacts upon stage performance close to the surge line. It is also demonstrated that, in its current configuration, the accuracy of the 1-D model prediction diminishes significantly with increasing blade tip speed.
Having ascertained that the existing model requires further work, an evaluation of the vaneless diffuser modelling method currently employed within the existing 1-D model is undertaken. The comparison of the predicted static pressure recovery coefficient with test data demonstrated the inherent inadequacies in the resulting prediction, in terms of both magnitude and variation with flow rate. A simplified alternative method based on an equivalent friction coefficient is also presented that, with further development, could provide a significantly improved stage performance prediction.

Capital Markets Union and ending short-termism: lessons from the European Commission's public consultation

The European Commission’s initiative to establish a Capital Markets Union is in sharp conflict with the more radical goals of downsizing significantly certain financial activities and firms that have become too-big-to-fail and too-big-to-govern and of ending or at least drastically limiting extreme speculation and short-termism in finance and the real economy in order to increase financial stability. The recent public consultation on the Commission’s Green Paper Building a Capital Markets Union gives evidence of how weak such demands are compared to calls for deeper capital markets with more ‘shadow banking’ and rebuilding (sound) securitisation. The consultation is an example of how framing the problem and the refined better regulation agenda influence post-crisis financial reregulation and help to marginalize more radical ideas demanding a return to a more traditional banking model and transforming finance back to serving the real economy.

Stellenabbau im Pflegedienst der Krankenhäuser. Eine Analyse der Entwicklung zwischen 1991 und 2005

Hintergrund: Seit Mitte der 1990er Jahre findet ein Stellenabbau in Krankenhäusern statt, von dem insbesondere auch der Pflegedienst betroffen ist. Obwohl die Tatsache seit längerem bekannt ist, fehlt es noch an einer gründlichen Analyse und Aufbereitung der verfügbaren Daten, um sich ein fundiertes Bild über den Umfang, die Entwicklung, Ursachen und Auswirkungen machen zu können. Methoden: Primäre Datengrundlage sind die Daten der Krankenhausstatistik sowie der Gesundheitsausgabenrechnung des Statistisches Bundesamtes. Ergebnisse: Die Analyse führt zu dem Ergebnis, dass zwischen 1995 und 2005 insgesamt ca. 104.000 Vollzeitstellen für nicht-ärztliches Personal in Allgemeinkrankenhäusern abgebaut wurden. Der ärztliche Dienst wurde hingegen um ca. 19.000 Vollkräfte ausgebaut. Im Saldo ergibt dies einen Gesamtstellenabbau von ca. 85.000 Vollkräften. Der größte Teil des Stellenabbaus entfiel mit ca. 44.000 Vollzeitstellen auf den Pflegedienst. Im Jahr 2005 lag die Zahl der Vollkräfte im Pflegedienst der Allgemeinkrankenhäuser um 13,7 % unter dem Wert des Jahres 1995 und sogar noch unter dem Wert des Jahres 1991, als über einen Pflegenotstand in Krankenhäusern gesellschaftlich diskutiert wurde. Eine Analyse der Kostendaten der Allgemeinkrankenhäuser zeigt, dass der Stellenabbau im Pflegedienst nicht allein durch die Budgetdeckelung und Einführung des DRG-Systems erklärt werden kann. Mehr als die Hälfte des Stellenabbaus wäre auf Grund der allgemeinen Budgetentwicklung nicht erforderlich gewesen, sondern erfolgte offenbar, um im Rahmen einer internen Umverteilung Mittel für andere Zwecke freizusetzen. Gewinner der internen Umverteilung war der ärztliche Dienst. Vor dem Hintergrund der Ergebnisse zahlreicher internationaler Studien muss davon ausgegangen werden, dass der Stellenabbau bereits negative Auswirkungen auf die Qualität der Patientenversorgung hat. Die Ergebnisse internationaler Forschung zu diesem Thema weisen darauf hin, dass eine niedrigere Personalbesetzung in Pflegedienst das Risiko erhöht, als Patient im Krankenhaus eine schwerwiegende Komplikation zu erleiden oder sogar zu versterben. Schlussfolgerungen: Es besteht dringender Handlungsbedarf, da sich die Personalbesetzung des Pflegedienstes in Allgemeinkrankenhäusern seit mehr als 10 Jahren in einer Abwärtsspirale befindet und mit weiterem Stellenabbau zu rechnen ist.

Exploring the effects of change on nursing practice in acute ambulatory care settings : a qualitative study

As a result of the current changes taking place in the delivery of acute care services, the emergence of acute ambulatory care (AAC) settings is expanding. According to a literature review, the volume, acuity, and complexity of patient care in these settings is increasing while the time the patients spend under the care of nurses is decreasing. Two forces, hospital downsizing and advancing technology, are identified as the major contributors to the shift in acute care delivery. The effects that these changes are having on the clinical nursing practice of registered nurses working in AAC settings are not known. Given that AAC settings are rapidly expanding, it can be anticipated that the delivery of nursing care will continue to be compressed into a shorter time frame. Therefore, the following qualitative research question was formulated: What are the problems and issues related to clinical nursing practice in acute ambulatory settings? The purpose of this study was to explore the problems and issues associated with change and clinical nursing practice including the educational needs of nurses working in MC settings. Specific objectives of the study included the following: (a) to explore the problems and issues related to nursing practice in select AAC settings; (b) to explore the similarities and differences in perspectives related to role expectation between nurse managers, nurse educators, and staff nurses; and (c) to develop a conceptual framework that will guide the construction of an instrument needed for further research. This study used semistructured individual interviews and focus group sessions to collect data from the three categories of registered nurses. More specifically, data were collected from one nurse manager, two charge nurses, two nurse educators and fifteen staff nurses, working in three different MC settings of a major teaching hospital. Collected data were separately analyzed by the researcher and an external rater following grounded theory methodology. By using open and axial coding, the problems and issues identified by nurses were grouped into several major and minor themes. In final analysis, by using selective coding, the four core themes (intensification, moderation, frustration, and adaptation) were extracted. Each core theme was presented and discussed in relation to hospital downsizing and advancing technology. The relationships among the four core themes were discussed and depicted in a model termed the "Impact and Consequence Model on Nursing Practice in MC Settings." Implications for further research are discussed and research hypotheses, based on the research findings, are presented.