京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18195号 / 人健博第12号 / 新制||人健||1(附属図書館) / 31053 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 任 和子, 教授 若村 智子, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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Indiana University-Purdue University Indianapolis (IUPUI) / The Bureau of Labor Statistics projected a shortage of registered nurses (RNs) growing to an estimated 581,500 by the year 2025 (an increase of 22 percent since 2008). Recent economical downturns have found many healthcare organizations experiencing a positive effect with the stabilization of nursing turnover. Once the economy begins to recover, however, experts predict the profession of nursing will still face the largest shortage in history according to projections by the American Nurses Association. Because lack of job satisfaction is a precursor to resignation, additional research regarding the identification of interventions that increase RN job satisfaction may result in retaining professionally qualified and prepared staff. This study proposed to identify through focus groups, staff nurse perceptions of nurse manager behaviors that influence RN staff nurse job satisfaction. A sample of 28 RNs, each participating in one of five focus groups, answered questions related to satisfaction with nurse manager behaviors. The investigator used qualitative content analysis to identify patterns within and across focus group data. Major findings of the study resulted in the identification of two conceptual categories (manager behaviors supportive of RNs and RN’s perceived disconnect of work issues from the manager’s role) and three major themes related to supportive behaviors (communication, respect, and feeling cared for). The results suggest the following as staff nurse preferences for nurse manager behaviors: open and honest communication that involves listening, consistency, and confidentiality; an increased level of respect including fairness and recognition of a job well done; and the sense of feeling cared for as when a manager meets individual needs and supports staff as professionals. The investigator compared the categories and themes to previous tools used in healthcare, which indicate the need for further item and/or tool development as well as further research regarding RNs’ perceived disconnect of work issues from the manager’s role.

Indiana University-Purdue University Indianapolis (IUPUI) / Caring relationships established between nurse managers and staff nurses promote positive work environments. However, research about staff nurses' perceptions of nurse manager caring behaviors is limited. A 94-item Caring Assessment Tool-Administration (CAT-adm©) was developed to measure staff nurses' perceptions of nurse managers' caring behaviors; however, it lacked robust psychometric testing. This study was undertaken to establish the CAT-adm© survey as a reliable and valid tool to measure staff nurses' perceptions of nurse managers' caring behaviors. The Quality-Caring Model® (QCM®) served as the theoretical framework. Specific aims were to 1) evaluate construct validity of the CAT-adm© survey by describing factors that account for variance in staff nurses' perceptions of nurse manager caring, 2) estimate internal consistency, and 3) conduct item reduction analysis. Four research questions were: 1) Will the factor structure of observed data fit an 8-factor solution? 2) What is the internal consistency reliability of the CAT- adm©? 3) What items can be reduced while maintaining an acceptable factor structure? and 4) What are staff nurses' perceptions of nurse manager caring behaviors? A cross-sectional descriptive design was used. A sample of 703 staff nurses from Midwestern, Midatlantic and Southern Regions of the U.S. completed the CAT-adm© survey electronically. Analysis included Confirmatory Factor Analysis (CFA), Exploratory Factor Analysis (EFA), univariate analysis, and descriptive statistics. CFA did not support an 8-factor solution. EFA supported a two-factor solution and demonstrated significant shared variance between the two factors. This shared variance supported a one-factor solution that could conceptually be labeled Caring Behaviors. Random selection reduced the scale to 25-items while maintaining a Cronbach's Alpha of .98. Using the new 25-item scale, the composite score mean of staff nurses' perceptions of nurse manager caring behaviors indicated a moderately high level of caring. Suggestions for nursing administration, nurse manager practice, leadership, education and for future research were given. The new 25-item CAT-adm© survey has acceptable reliability and validity. The 25-item CAT-adm© survey provides hospital administrators, nurse managers, and researchers with an instrument to collect valuable information about the caring behaviors used by nurse managers in relationship with staff nurses.

Current situation: Educated and qualified nurse can fully do her job, give a patient bio-psycho-social-spiritual needs and satisfy them. This can happen only if optimal conditions are given to her, which means the optimal number of nursing staff. The aim of the study was to set the optimal number of nursing staff at surgical department in the Hospital of the Vysočina region, which was chosen. A standardized methodology of Pochylá and Pochylý (1999 and 2008) was used. Methodology and the research complex: Quantitative-qualitative method was used in the research. Detailed interviews were used in the first part of the study while talking to nurses of the surgical department of the Hospital of the Vysočina region. In phase two, 26 special nursing procedures were selected and divided into four thematic parts. 520 measurements were made in total, average time of making each special nursing procedure was set. In phase three, average values of nursing one patient in 12 hours at surgical department were set. Daily shots of the procedures were being taken for 14 days (Monday-Sunday). Optimal numbers of nursing staff and their qualified substitution in the Hospital of the Vysočina region were set in the last stage of the research. Results: The research question and three hypotheses were answered by performing and processing the research. The result is that there are statistically major differences in average value of basic and special nursing. 21 patients in average were treated in the hospital in the first week of research. The average nursing time for this number of patients in 12 hours was 3585 minutes 1027 minutes of basic nursing care and 1718 minutes of special nursing procedures. In the second week of research, 24 patients were treated at the department in average. The average nursing time for this number of patients was 3647 minutes in 12 hours 1036 minutes of basic nursing care and 1675 minutes of special nursing procedures. Statistically major differences were confirmed even during special nursing procedures. The longest average time was measured while incoming of patients, transferring, discharging (14,31 minutes) and the shortest average time was measure while applicating medicine into body cavities (0,5 minutes). Based on the research we can say that the number of staff at selected department is for a 12-hour shift optimal. Recommended number of full-time employees is 5, the real number is 5,4. Conclusion and recommendation: The output of this thesis is recommendation for management of nursing care regarding the issue of getting and maintaining the optimal number of nursing staff.

La reconnaissance au travail qui se base sur des jugements de gratitude afin de rétribuer le travail réellement effectué par le salarié, influence positivement les comportements discrétionnaires qui ne sont pas explicitement récompensés par les systèmes formels de rémunération. Dans cette recherche, nous nous sommes intéressés à la relation entre la reconnaissance au travail et les comportements discrétionnaires à savoir le comportement d’entraide et le comportement d’innovation tout en sachant que cette relation n’a pas été étudiée dans la littérature. Le but de notre recherche est de savoir dans quelle mesure la reconnaissance au travail impacte-t-elle le comportement d’entraide et le comportement d’innovation. Pour répondre à cette question, nous avons formulé l’hypothèse fondamentale que la reconnaissance au travail a un effet positif sur les deux comportements discrétionnaires à savoir le comportement d’entraide et le comportement d’innovation.Nous avons testé cette hypothèse en menant une étude qualitative auprès de 20 infirmiers que nous avons complétée par une étude quantitative réalisée auprès d’un échantillon de 215 infirmiers Tunisiens. Les résultats de notre étude nous ont permis d’identifier les formes de reconnaissance les plus explicatives du comportement d’entraide et du comportement d’innovation.Les résultats de notre recherche ont montré que les infirmiers sont en quête permanente de reconnaissance et qu’ils cherchent à rendre leur travail plus visible pour pouvoir garantir des différentes formes de reconnaissance parmi lesquelles certaines se sont révélées les plus explicatives des deux comportements discrétionnaires : le comportement d’entraide et le comportement d’innovation. Notre recherche présente un caractère novateur et apporte une contribution autour de l’étude de la reconnaissance au travail comme étant un facteur qui favorise l’adoption du comportement d’entraide et du comportement d’innovation. / Recognition at work is based on gratitude judgments in order to reward the good work performed by the employee and positively influences the discretionary behaviors that are not explicitly reward with formal compensation systems.This doctoral dissertation studies the relationship between recognition at work and discretionary behaviors, particularly the helping and innovative behavior.This research aims to find out by which means recognition at work affects helping behavior an innovative behavior. To do so, we suggested and exam this fundamental hypothesis that employee recognition at work has positive effect on both discretionary behaviors namely helping behavior and innovative behavior.We tested this hypothesis by conducting a qualitative study on a sample of 20 nurses that we have completed with a quantitative study conducted among a sample of 215 Tunisians nurses. The results of our study allowed us to identify the most explanatory forms of recognition of the helping behavior and innovation behavior.The results of our doctoral dissertation showed that nurses are constantly in search of recognition and they are looking to make their work more visible in order to ensure different forms of recognition, some of this forms have proved the most explanatory of both discretionary behaviors.Our research is innovative and contributes to study the employee recognition as a factor that promotes the adoption of helping behavior and innovative behavior.

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