Workplace violence and intentions to quit: results from a survey of London nurses

Study Objective: Work-place violence, harassment and abuse is an increasing feature of nurses’ experience of work in many countries. There is some evidence that the experience of workplace violence affects levels of job satisfaction (Hesketh et al 2003) and career decisions (e.g. Mayer et al 1999, Fernandes et al 1999). This paper reports on verbal and physical abuse by patients, relatives and carers, as well as racial and sexual harassment in Acute Hospitals in London and investigates whether workplace violence affects nurses’ intentions to leave either their current job or the nursing profession, controlling for a number of other factors that are known to affect career decisions, such as workload, pay and own health. Method: A questionnaire designed by two of the authors (Reeves and West) to assess many different aspects of nurses work life was used in a postal survey of nurses grades A to I practising in twenty London acute trusts in 2002. A total of 6,160 clinical nurses were mailed the questionnaires and 2,880 returned completed questionnaires, resulting in an overall response rate of 47%, discounting undelivered questionnaires. Respondents worked in a wide variety of clinical settings but mainly in acute medical and surgical wards. In addition to descriptive statistics, results were analysed using logistic regression with robust standard errors: the appropriate test when the dependent variable is dichotomous and the individual respondents clustered within units (nurses working within hospitals are not statistically independent). Results: Our results show high levels of racial (%), sexual (%) and other, unspecified forms of harassment (%), as well as verbal and physical abuse (14% had been physically assaulted with 5% being assaulted more than once), over the previous 6 months. A very small number (1%) reported experiencing all three forms of harassment; 12% two forms and 29% one form. Only 45% of this sample intended to stay in nursing for at least 3 years; 40% were undecided and 15% intended to leave. Logistic regression estimates showed that reported levels of abuse and harassment had a significant impact on respondents’ career intentions, even in models that controlled for known factors affecting career decisions. About 70% of our respondents reported that they had had too little training in dealing with aggressive behaviour—or none at all—but there was no statistical relationship between lack of training and reported assaults. Conclusions: The international shortage of health care workers is due at least in part to low retention rates. It is crucial to investigate nurses’ experiences of work to identify the factors that shape their career decisions. Workplace violence is increasingly acknowledged as an international, service-wide, health care problem. This paper adds to the literature that shows that workplace violence has an impact on nurses’ career decisions. The implications for managers and policy makers are that strengthening systems of security and providing nurses with training in interpersonal relationships including dealing with aggressive patients could slow nurse turnover.

The impact of the nursing workforce on patient outcomes in intensive care

Introduction: Evidence from studies conducted mainly in the US and mainland Europe suggests that characteristics of the workforce, such as nurse patient ratios and workload (measured in a number of different ways) may be linked to variations in patient outcomes across health care settings (Carmel and Rowan 2001). Few studies have tested this relationship in the UK thus questions remain about whether we are justified in extrapolating evidence from studies conducted in very different health care systems. Objectives: To investigate whether characteristics of the nursing workforce affect patient mortality UK Intensive Care Units. Data: Patient data came from the case mix programme, Intensive Care National Audit and Research Centre (ICNARC), while information about the units came from a survey of all ICUs in England (Audit Comission 1998). The merged data set contained information on 43,859 patients in 69 units across England. ICNARC also supplied a risk adjustment variable to control for patient characteristics that are often the most important determinants of survival. Methods: Multivariate multilevel logistic regression. Findings: Higher numbers of direct care nurses and lower scores on measures of workload(proportion of occupied beds at the time the patient was admitted and mean daily transfers into the unit) were associated with lower mortality rates. Furthermore, the effect of the number of direct care nurses was greatest on the life chances of the patients who were most at risk of dying. Implications: This study has wide implications for workforce policy and planning because it shows that the size of the nursing workforce is associated with mortality (West et al 2006). Few studies have demonstrated this relationship in the UK. This study has a number of strengths and weaknesses and further research is required to determine whether this relationship between the nursing workforce and patient outcomes is causal.

Parenting practices in Northern Ireland: evidence from the Northern Ireland Household Panel Survey

The impact of parental child-rearing practices on child outcomes has been the subject of much research and debate for many years. Studies carried out within a variety of disciplines and across a number of different countries in the world have indicated that parents tend to use a different pattern of rearing their sons than their daughters, and that child-rearing practices are related to the gender of the parent, as well as to the age and developmental stage of the child. However, there has been little research in Northern Ireland on child-rearing behaviours. In order to address this shortfall, this paper presents an analysis of parents’ perceptions of their interactions with their children. Data from Wave 3 of the Northern Ireland Household Panel Survey were analysed to explore aspects of ‘‘negative’’ parenting practices (arguing, yelling and use of physical punishment) as well as ‘‘positive’’ parenting practices (talking, praising and hugging). The participants were all parents (aged 16 years and over) with children under the age of 16 years living in the same household. Each parent reported his/her interaction with each child (up to a maximum of six children), and in total 1,629 responses were recorded. The results of the research supported previous findings from the United Kingdom and elsewhere, and indicated that the parenting styles of respondents in Northern Ireland were indeed related to the gender and age of the children and to the gender of the parents. The survey found that parents in Northern Ireland tend to have a harsher, more negative style of parenting boys than girls and that children in their teenage years have fewer positive interactions with their parents than younger children. The same parents and children will be followed up in 2007 in order to provide a longitudinal analysis of parent/child relationships in Northern Ireland.

The VLT-FLAMES survey of massive stars: stellar parameters and rotational velocities in NGC 3293, NGC 4755 and NGC 6611

An analysis is presented of VLT-FLAMES spectroscopy for three Galactic clusters, NGC3293, NGC4755 and NGC6611. Non-LTE model atmosphere calculations have been used to estimate effective temperatures (from either the helium spectrum or the silicon ionization equilibrium) and gravities (from the hydrogen spectrum). Projected rotational velocities have been deduced from the helium spectrum (for fast and moderate rotators) or the metal line spectrum (for slow rotators). The origin of the low gravity estimates for apparently near main sequence objects is discussed and is related to the stellar rotational velocity. The atmospheric parameters have been used to estimate cluster distances (which are generally in good agreement with previous determinations) and these have been used to estimate stellar luminosities and evolutionary masses. The observed Hertzsprung-Russell diagrams are compared with theoretical predictions and some discrepancies including differences in the main sequence luminosities are discussed. Cluster ages have been deduced and evidence for non-coeval star formation is found for all three of the clusters. Projected rotational velocities for targets in the older clusters, NGC3293 and NGC4755, have been found to be systematically larger than those for the field, confirming recent results in other similar age clusters. The distribution of projected rotational velocities are consistent with a Gaussian distribution of intrinsic rotational velocities. For the relatively unevolved targets in the older clusters, NGC3293 and NGC4755, the peak of the velocity distribution would be 250 km s(-1) with a full-width-half-maximum of approximately 180 km s(-1). For NGC6611, the sample size is relatively small but implies a lower mean rotational velocity. This may be evidence for the spin-down effect due to angular momentum loss through stellar winds, although our results are consistent with those found for very young high mass stars. For all three clusters we deduce present day mass functions with Gamma-values in the range of -1.5 to -1.8, which are similar to other young stellar clusters in the Milky Way.

The VLT-FLAMES survey of massive stars: mass loss and rotation of early-type stars in the SMC

We have studied the optical spectra of a sample of 31 O- and early B-type stars in the Small Magellanic Cloud, 21 of which are associated with the young massive cluster NGC 346. Stellar parameters are determined using an automated fitting method (Mokiem et al. 2005, A&A, 441, 711), which combines the stellar atmosphere code FASTWIND (Puls et al. 2005, A&A, 435, 669) with the genetic algorithm based optimisation routine PIKAIA (Charbonneau 1995, ApJS, 101, 309). Comparison with predictions of stellar evolution that account for stellar rotation does not result in a unique age, though most stars are best represented by an age of 1-3 Myr. The automated method allows for a detailed determination of the projected rotational velocities. The present day v(r) sin i distribution of the 21 dwarf stars in our sample is consistent with an underlying rotational velocity (v(r)) distribution that can be characterised by a mean velocity of about 160-190 km s(-1) and an effective half width of 100-150 km s(-1). The vr distribution must include a small percentage of slowly rotating stars. If predictions of the time evolution of the equatorial velocity for massive stars within the environment of the SMC are correct (Maeder & Meynet 2001, A&A, 373, 555), the young age of the cluster implies that this underlying distribution is representative for the initial rotational velocity distribution. The location in the Hertzsprung-Russell diagram of the stars showing helium enrichment is in qualitative agreement with evolutionary tracks accounting for rotation, but not for those ignoring vr. The mass loss rates of the SMC objects having luminosities of log L-star/L-circle dot greater than or similar to 5.4 are in excellent agreement with predictions by Vink et al. (2001, A&A, 369, 574). However, for lower luminosity stars the winds are too weak to determine. M accurately from the optical spectrum. Three targets were classified as Vz stars, two of which are located close to the theoretical zero-age main sequence. Three lower luminosity targets that were not classified as Vz stars are also found to lie near the ZAMS. We argue that this is related to a temperature effect inhibiting cooler from displaying the spectral features required for the Vz luminosity class.

La incidencia de los valores culturales en el voluntariado: el caso de Europa

La realidad del voluntariado es sumamente compleja hasta el punto de que resulta complicado definir y caracterizar el trabajo voluntario, dada la gran variedad de interpretaciones, motivaciones, variables sociodemográficas y aspectos culturales que configuran el perfil de los voluntarios. El objetivo de este trabajo es analizar la influencia conjunta de algunas variables sociodemográficas, así como de los valores culturales de índole secular o tradicional, sobre el perfil de los voluntarios en Europa. Además, se investiga qué variables orientan a los voluntarios hacia un determinado tipo de voluntariado u otro. Para ello se ha aplicado principalmente una metodología de regresión logística a partir de la información disponible en la European Value Study. Los resultados obtenidos ayudan a establecer una caracterización del voluntariado en Europa, y confirman la influencia de los valores culturales, en primer lugar, en la realización o no de trabajos de voluntariado, y en segundo lugar, en la elección que hacen estas personas del tipo de actividad con la que están comprometidos. Al analizar dos tipos de voluntariado de motivación supuestamente muy diferente, se concluye que existe un grupo de valores que influyen en ambos, aunque el sentido y la intensidad en la que lo hacen sea diferente; por otra parte, algunos valores tienen influencia o no en la realización de trabajos de voluntariado, dependiendo del tipo específico al que nos refiramos.

‘Care just changes your life’: Factors impacting on the mental health of children and young people in care in Northern Ireland.

This paper represents one element of a research project carried out into the mental health needs of children and young people with experiences of care in Northern Ireland. Focusing exclusively on qualitative data collected from 51 young people in care and aftercare, it discusses in the first instance how the challenges and difficulties faced by young people can manifest themselves in feelings and behaviours that may exemplify poor mental well-being. In doing so it provides an understanding of mental health in the context of these young people’s lives. Through offering a more detailed account of some of the specific issues that put these young people at increased risk, it highlights areas for further work and consideration as a means of protecting them against these risks. These include: dealing with experiences prior to care; easing and ‘‘normalising’’ the experience of living in care; and enhancing ‘‘safety nets’’ after care. A key objective of the research is to inform policy and practice through the accounts of children and young people. It is argued that more work needs to be done to find creative ways of enhancing the day-to-day experiences of young people while in care and when leaving care.

Effect of plane of nutrition of 1-and 2-year-old ewes in early and mid-pregnancy on ewe reproduction and offspring performance up to weaning

The objective of the present study was to determine the effect of plane of nutrition in early pregnancy (EP) and mid-pregnancy (W), on the productive performance of 1- and 2-year-old ewes and their offspring. Over 2 successive years, between days 0 and 39 after synchronized mating (EP), 1- (n=117) and 2- (n=52) year-old ewes were allowed 60% (low, L-EP), 100% (medium, M-EP) or 200% (high, H-EP) of requirements for maintenance (M). Between days 40 and 90 (MP), 1-year-old ewes were allowed 140% (M-MP) or 200% (H-MP), while 2-year-old ewes were allowed 80% (M-MP) or 140% (H-MP) of their M requirement. After day 90, all ewes were fed to meet requirements for late pregnancy. Increasing the plane of nutrition between days 0 and 39 resulted in increases in live weight (LW) (PM-EP>LEP), differences that in 1-year-old ewes were sustained to lambing (P0.05). These ewes exhibited more positive maternal behaviours (e.g. increased grooming frequency and duration, P

Nutritonal status of adult ewes during early and mid-pregnancy. 1. Effects of plane of nutrition on ewe reproduction and offspring performance to weaning

The objective of this study was to determine the effects of plane of nutrition during early and mid-pregnancy on the performance of mature ewes and their offspring. From day 0 to day 39 post mating (early pregnancy, EP), 82 multiparous ewes were fed to provide either 60% (low, L), 100% (medium, M) or 200% (high, H) of predicted metabolisable energy (ME) requirements for maintenance, following a synchronised mating. From day 40 to day 90 (mid-pregnancy, MP), ewes were provided with either 80% (M) or 140% (H) of ME requirements. After 90 days of gestation, all ewes were fed to meet requirements for late pregnancy. During EP, mean live weight (LW) and body condition score (BCS) change of ewes were -6.3, -0.8 and +6.0kg and -0.02, +0.10 and +0.22 units in the L-, M- and H-EP treatments, respectively. During MP, mean LW and BCS change were -0.8 and +4.9kg and -0.09 and +0.09 units in the M- and H-MP treatments, respectively (P 0. 05) on conception rate, although there tended to be an inverse relationship (P = 0.085) between plane of nutrition in EP and plasma progesterone concentrations at day 42 of gestation. EP nutrition influenced foetal development with lambs from ewes offered diet L-EP being smaller (P

A comparative study of nursing attitudes towards young male survivors of brain injury: A questionnaire survey.

Background The attitudes members of the nursing profession hold towards survivors of brain injury may impact on the level of help, and degree of involvement they are willing to have. Given that the manner in which an individual receives their brain injury has been shown to impact on public prejudices, the importance of exploring nursing attitudes to this vulnerable group, and the subsequent impact this may have on the caring role, requires investigation. Objective To investigate the attitudes held by members of the nursing profession towards young male survivors of brain injury whose behaviour either contributed, or did not contribute, to their injury. Design Independent groups design. Setting and participants Ninety trainee and sixty-nine qualified nurses respectively drawn from a university in the south west of England and the emergency, orthopaedic and paediatric Departments of the Royal Devon and Exeter Hospital, UK. Methods Participants were randomly assigned to one of four fictional brain injury scenarios. A young male character was portrayed as sustaining a brain injury as a result of either an aneurysm, or through drug taking, with their behaviour being either a contributory or non-contributory factor. On reading these, participants were asked to complete the prejudicial evaluation scale, the social interaction scale and the helping behaviour scale. Results Analysis of variance showed that qualified nurses held more prejudicial attitudes than student nurses towards survivors of brain injury. Mean scores indicated that individuals seen as contributing towards their injury were likely to experience more prejudice (blame total = 42.35 vs. no blame total = 38.34), less social interaction (blame total = 37.54 vs. no blame total = 41.10), and less helping behaviour (blame total = 21.49 vs. no blame total = 22.34) by both groups. Conclusions Qualified nurses should be mindful of the impact their attitudes and judgements of survivors of brain injury may have on the subsequent care they provide. Greater emphasis on the effects of negative attitudes on patient interactions during training may provide nurses with the understanding to recognise and avoid challenges to their caring role in the future.

Bereavement Assessment Practice in Hospice Settings: Challenges for Palliative Care Social Workers

The management and delivery of bereavement support services in palliative care settings presents practical and ethical challenges. A national survey, conducted in 2007, examined bereavement practice in ten Marie Curie hospices across the United Kingdom. This qualitative study was undertaken using semi-structured telephone interviews with Bereavement Service Leaders located in each hospice. Although findings revealed that bereavement services were in operation and had been reviewed in response to the National Institute for Clinical Excellence Guidance (2004), and all bereaved families were offered support, there was no standardisation of service delivery across sites. Multi-disciplinary team meetings facilitated shared decision-making for bereavement follow-up, and expanded and clarified documentation completed by nursing staff around the time of the patient’s death. However, there was ambiguity regarding professional ‘duty of care’ and agency responses to bereaved individuals who were suicidal. Questions were raised around clinical effectiveness, reliability and professional accountability. The study highlighted ethical issues centred on documentation, user participation and consent, and found staff training was variable across the 10 hospices. The findings have informed the development of a post-bereavement service model which has been subsequently implemented across Marie Curie Cancer Care.