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.

Environmental factors associated with active living in retirement village residents : findings from an exploratory qualitative enquiry

This exploratory enquiry employs qualitative methods to advance knowledge and understanding of physical environmental attributes related to active living among residents of Australian retirement villages. Six focus groups (n = 51 residents) were held and participants described how their current, and subsequently ideal, retirement village and neighborhood supported active lifestyles. Thematic analysis revealed three key environmental factors associated with active living: a positive social environment within the village; services and facilities provided in the village and wider neighborhood; and the presence of suitable pedestrian infrastructure. The unique discovery that environmental factors of both the retirement village and the surrounding neighborhood were associated with residents’ active living raises many questions for study. Findings informed the development of a survey instrument, and further understanding in this area has the potential to contribute to the design and siting practices of senior housing complexes within neighborhoods.

Family, state, class and solidarity: re-conceptualising intergenerational solidarity through the grounded theory approach

The relationship between class and intergenerational solidarities in the public and private spheres calls for further conceptual and theoretical development. This article discusses the findings from the first wave of a qualitative longitudinal study entitled Changing Generations, conducted in Ireland in 2011–2012, comprising 100 in-depth interviews with men and women across the age and socioeconomic spectrums. Constructivist grounded theory analysis of the data gives rise to the following postulates: (1) intergenerational solidarity at the family level is strongly contoured by socioeconomic status (SES); (2) intergenerational solidarity evolves as family generations observe each others’ practices and adjust their expectations accordingly; (3) intergenerational solidarity within families is also shaped by the public sphere (the welfare state) that generates varying expectations and levels of solidarity regarding State supports for different age groups, again largely dependent on SES; (4) the liberal welfare state context, especially at a time of economic crisis, enhances the significance of intergenerational solidarity within families. We conclude by calling for research that is attuned to age/generation, gender and class, and how these operate across the family and societal levels.

The Meaning of Drug Use among Homeless Young People:A longitudinal pathways analysis

A strong link between drug use and homelessness has long since been documented in the international literature. However, much of the research has concentrated on the direction of the relationship between drug use and homelessness, seeking to establish drug use as a cause or consequence of homelessness, with far less attention to the intersection of drug and homeless ‘careers’. This paper examines the drug and homeless pathways of young people who are participants in a qualitative longitudinal study of homeless youth in Dublin, Ireland. The findings highlight downward drug transitions as associated with exiting homelessness and continued or escalated consumption as associated with remaining homeless. Analyses of the meanings young people attach to drug use over time reveal the importance of housing as an enabler to engaging with treatment and as assisting the process of becoming and remaining drug free. Young people who remained homeless did not accept their situations, as ‘acculturation’ accounts would suggest; rather, they aspired to changing their situations. However, they also face strong barriers to accessing housing which in turn hamper their efforts to address the matter of their drug use. The implications for how the homeless/drug use ‘nexus’ is conceptualised and understood, as well as implications for policy, are discussed.

Sibling caringscapes: time–space practices of caring within youth-headed households in Tanzania and Uganda

This paper investigates the time–space practices of young people caring for their siblings in youthheaded households affected by AIDS in Tanzania and Uganda. Based on qualitative exploratory research with young people heading households, their siblings, NGO workers and community members, the article develops the notion of sibling ‘caringscapes’ to analyse young people’s everyday practices and caring pathways through time and space. Participatory time-use data reveals that older siblings of both genders regularly undertake substantial caring tasks at the very high end of the caregiving continuum. Drawing on rhythmanalysis, the paper explores how young people negotiate emotional geographies and temporalities of caring. The competing rhythms of bodies, schooling, work and seasonal agricultural production can result in ‘arrhythmia’ and time scarcity, which has detrimental effects on young people’s health, education,future employment prospects and mobility. Young people’s lifecourse transitions are shaped to a large extent by their caring responsibilities, resulting in some young people remaining in a liminal position for considerable periods, unable to make ‘successful’ transitions to adulthood. Despite structural constraints,however, young people are able to exercise some autonomy over their caring pathways and lifecourse transitions. The research sheds light on the ways that individuals embody the practices, routines and rhythms of everyday life and exercise agency within highly restricted broader landscapes of care.

Ethical performance evaluation (EPE) in business practices: framework and case illustrations

Purpose – A set of principal parameters (i.e. time, context, gap, outcome, and consequence) influences the ethical performance evaluation (EPE) of business practices in the marketplace and society. The purpose of this paper is to describe a managerial framework of EPE based upon these parameters.

Design/methodology/approach – Case illustrations are used to underpin the introduced managerial framework of EPE.

Findings – The EPE of business practices is not only dependent upon the ethical values and principles of today, but those principles of tomorrow may be equally, or even more, crucial. The EPE of business practices is also dependent upon the surrounding context and its specific ethical values and principles. Furthermore, it is dependent upon the gap between different perceptions of ethical values and principles and if the outcome of the corporation's ethical values and principles are proactive or reactive in relation to the reigning ethical values and principles in the marketplace and society. Finally, it is also dependent upon the potential and eventual consequences of ethical values and principles.

Research limitations/implications – The only way that we can “objectively” evaluate past ethical values and principles is through the use of ethical values and principles at the time and in respect to the context at hand. Research tends to fail when considering the longitudinal and evolutionary dimensions in the exploration of ethical values and principles in business practices. There is too much focus upon on-the-spot-accounts in the past and in current research efforts. An important area for further research is how to deal with the durability and variability of ethical values and principles in business practices in the marketplace and society. The key may be a stronger emphasis on longitudinal research efforts that may explore them over time and as contexts evolve. Ethical values and principles are connected and re-connected over time and across contexts in one way or another. They have a past, a current status and a future.

Practical implications – The decision as to whether business practices are ethical or unethical is – relatively speaking – easy to determine from a narrow perspective, however, the decision whether business practices are ethical or unethical becomes complicated as the perspective is widened and deepened. An introduced managerial framework of EPE provides a generic foundation and structure to examine the acceptability versus unacceptability of business practices.

Originality/value – The paper introduces a managerial framework of EPE, followed by case illustrations. It addresses the impact of time on ethical values and principles in any context on the potential and eventual gaps, outcomes and consequences in business practices. The managerial framework of EPE may also be used in non-business areas whenever found applicable and convenient to use.

Experiences of disability consumer-directed care users in Australia : results from a longitudinal qualitative study

The rapidly growing body of literature suggests that Consumer-directed Care (CDC) has the potential to empower consumers and improve the flexibility and quality of care. However, reports highlighting quality and risk concerns associated with CDC focusing on a longer time frame have been few. This paper presents the findings from a qualitative longitudinal evaluation of an Australian CDC programme. Focusing on the period between 2003 and 2008, it reports on the experiences of 12 families caring for a dependent family member. It is based on two external evaluations completed 6 and 36 months after enrolment, and one internal evaluation completed 48 months after enrolment. The findings were triangulated with internal memos, reports and minutes of meetings, as well as with the theoretical literature. The study demonstrates that CDC harbours considerable benefits for people with disabilities and their carers. However, the study also suggests that, over time, carers may experience an increased sense of isolation and lack of support as a result of their involvement in the CDC programme. The paper argues that the development of safeguards addressing these weaknesses is crucial for the sustainability of CDC programmes in contexts where risk cannot be simply transferred onto consumers.

"It's no skin off my nose":Why people take part in qualitative research

In this article, the authors analyze participants' accounts of why they took part in a repeat-interview study exploring newly diagnosed patients' perceptions of diabetes service provision in Lothian, Scotland. The study involved three semistructured in-depth interviews with each patient (N = 40), which spanned a year. The authors provide a thematic discursive analysis of responses to the question, Can I ask you what made you decide to part in the study and why you've stayed involved over the past year? The main themes are (a) recruitment within health contexts ("the nurse said it would help"), (b) altruism ("if it can help somebody"), (c) qualitative research being seen as inherently innocuous ("nothing to lose"), and (d) therapeutic aspects of interviewing ("getting it off my chest"). The analysis contributes both to the qualitative literature about generic research participation and to a germinal literature exploring qualitative health research participation. © 2006 Sage Publications.

Building cliques and alliances as practices to 'make things happen' in complex networks

The Roma population has become a policy issue highly debated in the European Union (EU). The EU acknowledges that this ethnic minority faces extreme poverty and complex social and economic problems. 52% of the Roma population live in extreme poverty, 75% in poverty (Soros Foundation, 2007, p. 8), with a life expectancy at birth of about ten years less than the majority population. As a result, Romania has received a great deal of policy attention and EU funding, being eligible for 19.7 billion Euros from the EU for 2007-2013. Yet progress is slow; it is debated whether Romania's government and companies were capable to use these funds (EurActiv.ro, 2012). Analysing three case studies, this research looks at policy implementation in relation to the role of Roma networks in different geographical regions of Romania. It gives insights about how to get things done in complex settings and it explains responses to the Roma problem as a „wicked‟ policy issue. This longitudinal research was conducted between 2008 and 2011, comprising 86 semi-structured interviews, 15 observations, and documentary sources and using a purposive sample focused on institutions responsible for implementing social policies for Roma: Public Health Departments, School Inspectorates, City Halls, Prefectures, and NGOs. Respondents included: governmental workers, academics, Roma school mediators, Roma health mediators, Roma experts, Roma Councillors, NGOs workers, and Roma service users. By triangulating the data collected with various methods and applied to various categories of respondents, a comprehensive and precise representation of Roma network practices was created. The provisions of the 2001 „Governmental Strategy to Improve the Situation of the Roma Population‟ facilitated forming a Roma network by introducing special jobs in local and central administration. In different counties, resources, people, their skills, and practices varied. As opposed to the communist period, a new Roma elite emerged: social entrepreneurs set the pace of change by creating either closed cliques or open alliances and by using more or less transparent practices. This research deploys the concept of social/institutional entrepreneurs to analyse how key actors influence clique and alliance formation and functioning. Significantly, by contrasting three case studies, it shows that both closed cliques and open alliances help to achieve public policy network objectives, but that closed cliques can also lead to failure to improve the health and education of Roma people in a certain region.

Professional standards research:job satisfaction and innovation

Job satisfaction is a significant predictor of organisational innovation – especially where employees (including shop-floor workers) experience variety in their jobs and work in a single-status environment. The relationship between job satisfaction and performance has long intrigued work psychologists. The idea that "happy workers are productive workers" underpins many theories of performance, leadership, reward and job design. But contrary to popular belief, the relationship between job satisfaction and performance at individual level has been shown to be relatively weak. Research investigating the link between job satisfaction and creativity (the antecedent to innovation) shows that job dissatisfaction promotes creative outcomes. The logic is that those who are dissatisfied (and have decided to stay with the organisation) are determined to change things and have little to lose in doing so (see JM George & J Zhou, 2002). We were therefore surprised to find in the course of our own research into managerial practices and employee attitudes in manufacturing organisations that job satisfaction was a highly significant predictor of product and technological innovation. These results held even though the research was conducted longitudinally, over two years, while controlling for prior innovation. In other words, job satisfaction was a stronger predictor of innovation than any pre-existing orientation organisations had towards working innovatively. Using prior innovation as a control variable, as well as a longitudinal research design, strengthened our case against the argument that people are satisfied because they belong to a highly innovative organisation. We found that the relationship between job satisfaction and innovation was stronger still where organisations showed that they were committed to promoting job variety, especially at shop-floor level. We developed precise instruments to measure innovation, taking into account the magnitude of the innovation both in terms of the number of people involved in its implementation, and how new and different it was. Using this instrument, we are able to give each organisation in our sample a "score" from one to seven for innovation in areas ranging from administration to production technology. We found that much innovation is incremental, involving relatively minor improvements, rather than major change. To achieve sustained innovation, organisations have to draw on the skills and knowledge of employees at all levels. We also measured job satisfaction at organisational level, constructing a mean "job satisfaction" score for all organisations in our sample, and drawing only on those companies whose employees tended to respond in a similar manner to the questions they were asked. We argue that where most of the workforce experience job satisfaction, employees are more likely to collaborate, to share ideas and aim for high standards because people are keen to sustain their positive feelings. Job variety and single-status arrangements further strengthen the relationship between satisfaction and performance. This makes sense; where employees experience variety, they are exposed to new and different ideas and, provided they feel positive about their jobs, are likely to be willing to try to apply these ideas to improve their jobs. Similarly, staff working in single-status environments where hierarchical barriers are reduced are likely to feel trusted and valued by management and there is evidence (see G Jones & J George, 1998) that people work collaboratively and constructively with those they trust. Our study suggests that there is a strong business case for promoting employee job satisfaction. Managers and HR practitioners need to ensure their strategies and practices support and sustain job satisfaction among their workforces to encourage constructive, collaborative and creative working. It is more important than ever for organisations to respond rapidly to demands of the external environment. This study shows the positive association between organisational-level job satisfaction and innovation. So if a happy workforce is the key to unlocking innovation and organisations want to thrive in the global economy, it is vital that managers and HR practitioners pay close attention to employee perceptions of the work environment. In a world where the most innovative survive it could make all the difference.

The knowledge, attitudes and beliefs of patients and their healthcare professionals around oral dosage form modification: a systematic review of the qualitative literature

Objectives: The objective of this systematic review was to synthesize the available qualitative evidence on the knowledge, attitudes and beliefs of adult patients, healthcare professionals and carers about oral dosage form modification. Design: A systematic review and synthesis of qualitative studies was undertaken, utilising the thematic synthesis approach. Data sources: The following databases were searched from inception to September 2015: PubMed, Medline (EBSCO), EMBASE, CINAHL, PsycINFO, Web of Science, ProQuest Databases, Scopus, Turning Research Into Practice (TRIP), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Citation tracking and searching the references lists of included studies was also undertaken. Grey literature was searched using the OpenGrey database, internet searching and personal knowledge. An updated search was undertaken in June 2016. Review methods: Studies meeting the following criteria were eligible for inclusion; (i) used qualitative data collection and analysis methods; (ii) full-text was available in English; (iii) included adult patients who require oral dosage forms to be modified to meet their needs or; (iv) carers or healthcare professionals of patients who require oral dosage forms to be modified. Two reviewers independently appraised the quality of the included studies using the Critical Appraisal Skills Programme Checklist. A thematic synthesis was conducted and analytical themes were generated. Results: Of 5455 records screened, seven studies were eligible for inclusion; three involved healthcare professionals and the remaining four studies involved patients. Four analytical themes emerged from the thematic synthesis: (i) patient-centred individuality and variability; (ii) communication; (iii) knowledge and uncertainty and; (iv) complexity. The variability of individual patient’s requirements, poor communication practices and lack of knowledge about oral dosage form modification, when combined with the complex and multi-faceted healthcare environment complicate decision making regarding oral dosage form modification and administration. Conclusions: This systematic review has highlighted the key factors influencing the knowledge, attitudes and beliefs of patients and healthcare professionals about oral dosage form modifications. The findings suggest that in order to optimise oral medicine modification practices the needs of individual patients should be routinely and systematically assessed and decision-making should be supported by evidence based recommendations with multidisciplinary input. Further research is needed to optimise oral dosage form modification practices and the factors identified in this review should be considered in the development of future interventions.

Development of management accounting practices in energy operations in a forest industry Company

The aim of this master’s thesis was to map the management accounting processes and reporting of an internal service unit. The research was conducted in energy services in a forest industry company. Research questions and the results of the study are highly specific for the case unit although some generalizable features of management accounting in internal service units under shared services were searched. The research was carried out as a qualitative action research and a single case study. Internal benchmarking was used to find best practices from other units and to get a comprehensive understanding of the financial processes of the case company. Empirical data for the study was collected with participant observation, interviews of experts and by exploring internal company documents. A literature review was conducted to outline the subject and to support the study. Although the management accounting processes of the case unit were found to be on a good level, some improvement ideas were presented. Results of the research show that the needs of the customers are in the key role in the processes of an internal service unit. Management accounting and reporting need to support the company strategy and management decision-making. To evaluate the performance of the service unit both financial and non-financial measures are needed.

Meeting art with art : arts-based methods enhance researcher reflexivity in research with mental health service users

This paper presents a rationale for arts-based practices in music therapy research, and provides an example of using ABR techniques in research. Arts-based materials are increasingly demonstrated to have the capacity to extend processes of reflexivity and analysis in a range of qualitative health research studies. By comparison, music therapy research studies have rarely employed arts-based methods or techniques. There is a need for more studies in music therapy that employ arts-based research to demystify and elaborate a wider range of creative approaches within music therapy inquiry. In the study described in this paper, ABR was used to reflect on the contribution of a service user in a community mental health context who participated in a focus group about his experiences of music therapy. ABR was found to offer a creative way to engage service users, and to deepen and extend the researcher's reflexivity when responding to materials created by research participants.