Empowering Nursing Leaders to Facilitate Healthy Work Environments: First Steps

The purpose of this project was to examine the literature for perspectives on healthy work environments (HWE). HWEs have been identified as important factors in the nursing profession to enhance recruitment, retention, job satisfaction, and accountability. This paper identifies that the front line manager is an essential role within organizations, and directly impacts work environments. Within this paper it has been pointed out that professional organizations have provided some general recommendations for improving work environments which include increasing nurses’ accountability and teamwork, providing opportunities for shared decision making, having supportive leadership, providing recognition, educational support, and adequate staffing. However, enacting them all can be difficult due to front line manager capacity, the impending nursing shortage, organizational resources and barriers. Based on the literature, conclusions have been drawn and recommendations for future research have been identified. HWE strategies have been developed with implementation plans for my practice area.

Is the Front Line Prepared for the Changing Faces of Patients? Predictors of Cross-Cultural Preparedness Among Clinical Nurses and Resident Physicians in Lausanne, Switzerland.

UNLABELLED: Phenomenon: Assuring quality medical care for all persons requires that healthcare providers understand how sociocultural factors affect a patient's health beliefs/behaviors. Switzerland's changing demographics highlight the importance of provider cross-cultural preparedness for all patients-especially those at risk for social/health precarity. We evaluated healthcare provider cross-cultural preparedness for commonly encountered vulnerable patient profiles. APPROACH: A survey on cross-cultural care was mailed to Lausanne University hospital's "front-line healthcare providers": clinical nurses and resident physicians at our institution. Preparedness items asked "How prepared do you feel to care for ... ?" (referring to example patient profiles) on an ascending 5-point Likert scale. We examined proportions of "4 - well/5 - very well prepared" and the mean composite score for preparedness. We used linear regression to examine the adjusted effect of demographics, work context, cultural-competence training, and cross-cultural care problem awareness, on preparedness. FINDINGS: Of 885 questionnaires, 368 (41.2%) were returned: 124 (33.6%) physicians and 244 (66.4%) nurses. Mean preparedness composite was 3.30 (SD = 0.70), with the lowest proportion of healthcare providers feeling prepared for patients "whose religious beliefs affect treatment" (22%). After adjustment, working in a sensitized department (β = 0.21, p = .01), training on the history/culture of a specific group (β = 0.25, p = .03), and awareness regarding (a) a lack of practical experience caring for diverse populations (β = 0.25, p = .004) and (b) inadequate cross-cultural training (β = 0.18, p = .04) were associated with higher preparedness. Speaking French as a dominant language and physician role (vs. nurse) were negatively associated with preparedness (β = -0.26, p = .01; β = -0.22, p = .01). Insights: The state of cross-cultural care preparedness among Lausanne's front-line healthcare providers leaves room for improvement. Our study points toward institutional strategies to improve preparedness: notably, making sure departments are sensitized to cross-cultural care resources and increasing provider diversity to reflect the changing Swiss demographic.

Clinical outcome and biological characteristics of Chronic Myeloid Leukemia patients treated with nilotinib front-line

The present work reports the outcome of the GIMEMA CML WP study CML0811, an independent trial investigating nilotinib as front-line treatment in chronic phase chronic myeloid leukemia (CML). Moreover, the results of the proteomic analysis of the CD34+ cells collected at CML diagnosis, compared to the counterpart from healthy donors, are reported. Our study confirmed that nilotinib is highly effective in the prevention of the progression to accelerated/blast phase, a condition that today is still associated with high mortality rates. Despite the relatively short follow-up, cardiovascular issues, particularly atherosclerotic adverse events (AE), have emerged, and the frequency of these AEs may counterbalance the anti-leukemic efficacy. The deep molecular response rates in our study compare favorably to those obtained with imatinib, in historic cohorts, and confirm the findings of the Company-sponsored ENESTnd study. Considering the increasing rates of deep MR over time we observed, a significant proportion of patients will be candidate to treatment discontinuation in the next years, with higher probability of remaining disease-free in the long term. The presence of the additional and complex changes we found at the proteomic level in CML CD34+ cells should be taken into account for the investigation on novel targeted therapies, aimed at the eradication of the disease.

A Study of role conflict, role ambiguity, locus of control, job satisfaction and participation in decision making among front-line vocational service workers for mentally retarded adults

This study was an investigation of individual and organizational factors, as perceived by front-line vocational service workers from Adult Rehabilitation Centres (ARC Industries) for mentally retarded adults. The specific variables which were measured included role conflict/role ambiguity (role factors), internal/external locus of control (individual differences), job satisfaction with work and supervision (job attitudes) and participation in deci~ion making (organizational factor). The exploration of these constructs was conducted by means of self-report questionnaires which were completed by sixty-nine out of a total of ninety front-line employees. The surveys were distributed in booklet form to nine distinct rehabilitation facilities from St. Catharines, West Lincoln, Greater Niagara, Port Colborne, WeIland, Fort Erie, Hamilton, Guelph and Brantford. The survey data was evaluated by the statisti.cal Package for the Social Sciences (SPSS) which used the Pearson Product Moment Correlation procedure and a compar~son of means test. A comparison of correlation coefficients test was also conducted. This statistical procedure was calculated mathematically. The results obtained from the statistical evaluation confirmed the prediction that self-reported measures of participation in decision making and satisfaction (work and supervision) would be negatively correlated with role conflict and role ambiguity. As well, the speculation that perceived satisfaction (work and supervision) would be positively correlated with participation in decision making was empirically supported. Internal and external locus of control did not contribute to a significant difference in r~sponses to role perceptions (conflict and ambiguity) , satisfaction (work and supervision) or the correlational relationship between participation in decision making and satisfaction (work and supervision). Overall, the findings from this study substantiated the importance of examining employee perceptions in the workplace and the interrelationships among individual and organizational variables. This research was considered a contribution to the general area of occupational stress and to the study of individuals in work organizations.

Direct support and general support maintenance : truck, utility: 1/4-ton, 4X4, M151A2 (2320-00-177-9258); truck, utility: 1/4-ton, 4X4, M825 (2320-00-177-9257) with 106MM recoilless rifle; truck, ambulance, front line: 1/4-ton, 4X4, M718A1 (2310-00-177-9256).

Includes index.

Organizational maintenance manual : truck, utility, 1/4 ton, 4x4, M151 (2320-542-4783), M151A1 (2320-763-1092), M151A2 (2320-177-9258); truck, utility, 1/4 ton, 4x4, M151A1C (2320-763-1091), M825 (2320-177-9257) with 106 mm recoilless rifle; truck, ambulance, front line, 1/4 ton, 4x4 ....

Includes index.

Front line cost administration; a factual approach to industrial engineering methods which explain and promote the use of cost administration tactics to the front line administrator, the foreman.

Mode of access: Internet.

The definition, theoretical modelling and empirical research of front-line service employee corporate identity within a UK national grocery retailer:determining the FLE corporate brand identification construct

Over the past forty years the corporate identity literature has developed to a point of maturity where it currently contains many definitions and models of the corporate identity construct at the organisational level. The literature has evolved by developing models of corporate identity or in considering corporate identity in relation to new and developing themes, e.g. corporate social responsibility. It has evolved into a multidisciplinary domain recently incorporating constructs from other literature to further its development. However, the literature has a number of limitations. It remains that an overarching and universally accepted definition of corporate identity is elusive, potentially leaving the construct with a lack of clear definition. Only a few corporate identity definitions and models, at the corporate level, have been empirically tested. The corporate identity construct is overwhelmingly defined and theoretically constructed at the corporate level, leaving the literature without a detailed understanding of its influence at an individual stakeholder level. Front-line service employees (FLEs), form a component in a number of corporate identity models developed at the organisational level. FLEs deliver the services of an organisation to its customers, as well as represent the organisation by communicating and transporting its core defining characteristics to customers through continual customer contact and interaction. This person-to-person contact between an FLE and the customer is termed a service encounter, where service encounters influence a customer’s perception of both the service delivered and the associated level of service quality. Therefore this study for the first time defines, theoretically models and empirically tests corporate identity at the individual FLE level, termed FLE corporate identity. The study uses the services marketing literature to characterise an FLE’s operating environment, arriving at five potential dimensions to the FLE corporate identity construct. These are scrutinised against existing corporate identity definitions and models to arrive at a definition for the construct. In reviewing the corporate identity, services marketing, branding and organisational psychology literature, a theoretical model is developed for FLE corporate identity, which is empirically and quantitatively tested, with FLEs in seven stores of a major national retailer. Following rigorous construct reliability and validity testing, the 601 usable responses are used to estimate a confirmatory factor analysis and structural equation model for the study. The results for the individual hypotheses and the structural model are very encouraging, as they fit the data well and support a definition of FLE corporate identity. This study makes contributions to the branding, services marketing and organisational psychology literature, but its principal contribution is to extend the corporate identity literature into a new area of discourse and research, that of FLE corporate identity

Understanding key mechanism by which internal communication influences prosocial service behaviors of front-line employees

This paper contributes to the prosocial service behavior (PSB) literature by investigating the nature of the relationships between internal communication and PSBs, and whether role stress and organizational commitment mediate these relationships. According to the literature, internal communication plays an important role in influencing FLEs job attitudes and behaviors, as well as reducing role stress. Data collected from FLEs in a UK based service organization was used to test our conceptual framework. The results show that FLE perceptions of internal communication practices influence their role stress and organizational commitment, which, in turn, affect the performance of PSBs. Our findings highlight the significance of studying role stress and organizational commitment as mediators in the relationship between internal communication and PSBs, and shed light on the mechanisms by which internal communication influences PSBs. The limitations of the study are then sketched, and suggestions for future research are also made.

Internal communication and prosocial service behaviors of front-line employees:investigating mediating mechanisms

This paper contributes to the prosocial service behavior (PSB) literature by developing and testing a conceptual framework to investigate the mediating mechanisms underlying the relationships between internal communication and PSBs. Data collected from front-line employees (FLEs) in a UK based service organization was used to test our conceptual framework. Our findings demonstrate that FLE perceptions of internal communication practices influence their role stress and organizational commitment, which, in turn, influence their PSBs. The results highlight the significance of studying role stress and organizational commitment as mediators in the relationship between internal communication and PSBs. The limitations of the study are then sketched, and suggestions for future research are also provided.

Corporate identity at the stakeholder group level:a conceptual model of front-line employee corporate identity

There is a paucity of literature regarding the construction and operation of corporate identity at the stakeholder group level. This article examines corporate identity from the perspective of an individual stakeholder group, namely, front-line employees. A stakeholder group that is central to the development of an organization’s corporate identity as it spans an organization’s boundaries, frequently interacts with both internal and external stakeholders, and influences a firm’s financial performance by building customer loyalty and satisfaction. The article reviews the corporate identity, branding, services and social identity literatures to address how corporate identity manifests within the front-line employee stakeholder group, identifying what components comprise front-line employee corporate identity and assessing what contribution front-line employees make to constructing a strong and enduring corporate identity for an organization. In reviewing the literature the article develops propositions that, in conjunction with a conceptual model, constitute the generation of theory that is recommended for empirical testing.

U.S. Army front line artillery observation during the 1945 Okinawa campaign: An oral history case study

This dissertation explores the role of artillery forward observation teams during the battle of Okinawa (April–June 1945). It addresses a variety of questions associated with this front line artillery support. First, it examines the role of artillery itself in the American victory over the Japanese on Okinawa. Second, it traces the history of the forward observer in the three decades before the end of World War II. Third, it defines the specific role of the forward observation teams during the battle: what they did and how they did it during this three-month duel. Fourth, it deals with the particular problems of the forward observer. These included coordination with the local infantry commander, adjusting to the periodic rotation between the front lines and the artillery battery behind the line of battle, responding to occasional problems with "friendly fire" (American artillery falling on American ground forces), dealing with personnel turnover in the teams (due to death, wounds, and illness), and finally, developing a more informal relationship between officers and enlisted men to accommodate the reality of this recently created combat assignment. Fifth, it explores the experiences of a select group of men who served on (or in proximity to) forward observation teams on Okinawa. Previous scholars and popular historians of the battle have emphasized the role of Marines, infantrymen, and flame-throwing armor. This work offers a different perspective on the battle and it uses new sources as well. A pre-existing archive of interviews with Okinawan campaign forward observer team members conducted in the 1990s forms the core of the oral history component of this research project. The verbal accounts were checked against and supplemented by a review of unit reports obtained from the U.S. National Archives and various secondary sources. The dissertation concludes that an understanding of American artillery observation is critical to a more complete comprehension of the battle of Okinawa. These mid-ranking (and largely middle class) soldiers proved capable of adjusting to the demands of combat conditions. They provide a unique and understudied perspective of the entire battle.