Staff satisfaction with a productive mental health ward program

¶ … Respondents of the Study ( Population Characteristics)

The staff group was a convenience sample surveyed from five different inpatient wards that were located in local hospitals situated in (* a city in Australia?). There was a total of 100 participants, with * percentage of them being female, ranging from age * to *, the average age being.. The mean age of nurse's employment in the practice was * . Ethnicity ranged with * percent being Caucasian, * percent Blacks, and * of an alternate ethnicity.

Sampling and the Sample size

Factors such as accuracy and confidence, population size, time and cost constraints were taken into consideration in selecting sample size. Using the non-probability sampling technique where a convenience (accidental or haphazrd) sampling strategy was employed, a total of 100 respondents were selected as a sample of the study from five Mental Health inpatient wards ( this is the whole available population from these 5 wards). The respondents come from various job titles ( health care support workers to Ward Managers) and work experiences in order to enhance ethnic distribution and other differences so as to increase the generalization of the result.

Survey Instrument:

The survey was intended to assess the impact of the independent variable of Productive Mental Health Ward program on the dependent variable of staff satisfaction.

The questionnaire has two sections. The first section of the questionnaire invovled demographic questions (such as identification for pre and post comparison, work banding, optional sex and age, and length of experiences in the current ward and with NHS). The second section contained 21 questions under five categories where the staff can score their subjective perception from 0 to 5, where 0 is strongly disagree, 1 is moderately disagree, 2 is slightly disagree, 3 is slightly agree, 4 is moderately agree and 5 is strongly agree.

Category 1 assessed the working environment -- facilities, easy to find equipment and ward cleanliness.

Category 2 assessed the team work, staffing level and availability of information for them to work safely.

Category 3 assessed the ward routine -- workload, direct time with service users and provision of safe and supportive care.

Category 4 assessed ward management -- empowerment, management support, visible management, value etc.

Category 5 assessed staff well-being -- team support, stress, work-life balance and able to leave work behind after the shift.

The adjusted survey (see Index) contained the following additions: (a) staff identification, (b) staff grade or band, (c) staff age (d) sex of nurse (e) length of time in the current ward, and (f) length of service in NHS.

In all other ways, my survey stayed constant to the original including in that the subjects were asked to respond the same set of questions, in the same order, and that all the subjects had the same set of options for their responses

Response scale

The survey itself was rated according to a Likert scale of 0 to 5 where 0 represented 'Strongly Disagree; 1=Moderately Disagree', 2= Slightly Disagree; 3= Slightly Agree; 4=Moderately Agree; 5=Strongly Agree.

The survey was, further, divided into five categories. These were: Environment; Teamwork; Ward Routine; Ward Management; and Staff Well Being. Three items followed the first section, four items followed the next two sections, and the last two contained five items. Following each section was a space requesting comments or feedback regarding that section

Examples of questions included:

1. The staff facilities on my ward meet my needs (Environment)

2. We work well as a team (Teamwork)

3. I am happy with the workload that I have on each shift (Work Routine)

4. I feel empowered to make changes (Ward Management)

5. I feel supported in the team (Staff Well-being)

Validity and reliability of the instrument

The reliability of the instrument was assessed by means of the internal consistency and the test-rest coefficient. Using van Saane et al.'s (2003) study as basis, an instrument with an internal consistency coefficient of 0.80 or higher was considered adequate. In the absence of scale total, the ranges of the sub-scales in the instrument are considered. According to *Lloyd et al., the test-retest conflict, too, has to be 0.70 or higher. These are my measurements for reliability of the instrument.

Assessment of validity of the instrument is divided into three categories: (a) convergent validity, (b) discriminant validity, and (c) content validity. The last is addressed in the following section.

Convergent validity refers to the degree of correspondence between created instrument used in this study and a similar instrument employed for the same purpose (*17, 18). The degree of convergence assessed here would be correlation between this appended instrument and the original questionnaire on which it is based. Since it is closely connected to the original instrument, a moderate to high correlation is expected. Based on, the criterion of convergent validity was set for a minimal of 0.50, or the sub-scale correlation range starting from that same rate.

Discriminant validity is the reverse of convergent validity and defined as the degree of difference between created instrument used in this study and a similar instrument employed for the same purpose (*17, 18). There are three features of discriminant validity, two of which were not related here. The first is to investigate whether the instrument employed here is similar to another instrument, which, although similar, measures a different concept. This condition was irrelevant here, since the original instrument measures the same concept. Secondly, responsiveness between both instruments is investigated. This will best be known after reiterated testing of the modified instrument since an instatement first has to show reiterated stability (established by constant testing) before its responsiveness can be assessed.

Content Validity, Reliability

Content validity refers to the extent to which the instrument measures the concept defined by the researcher and that which the researcher intends to evaluate (*18). The content validity was assessed by examining the fit between the conditions associated with nurse satisfaction of work that were retrieved from the literature search. Since 'job satisfaction' is a tenuous and abstract conceptualization fluctuating from country to country and never definitely or unanimously assessed, I used the recommendation offered by the European Foundation for the Improvement of Living and Working Conditions (EFILWC). They advised that only a tenuous description can be gained and that research should take into account the country in which the original report was authored since the definition of 'job satisfaction' tends to hinge on national constructs. Since, as yet, no common framework for defining 'job satisfaction' exists, I employed the most recent and in-depth research on the subject as rough aid to the matter.

Sources of data

*Two literature searches were conducted in order to generate conditions of nurse satisfaction. One search centered on variables of work satisfaction described in relevant job satisfaction theories. The other search probed applicable reviews and meta-analysis for factors of job satisfaction relevant to the nurse profession.

The literature, in the first case, was plumbed for studies that provided theoretical insight into the concept of job satisfaction. Terms such as 'job satisfaction' and 'theory' were used to aid the research.

In the second case, research was conducted by using terms such as 'nursing', 'job satisfaction' and 'factors'. The resulting Meta analyses and literature reviews were thoroughly analyzed and only those relevant to the intent of the study retained. They had to, in other words, be congruent to the nursing profession and related to satisfaction that the employee gained from his or her job.

'Nurse satisfaction' as a result was, accordingly, broken down and defined into the following *ten categories: (1) Workload -- whether staff workload was reduced as a result of the program; (2) Empower -- whether staff felt greater empowerment and ability to do whir work; (3) Support -- whether staff felt that they received more support as a result of the program; (4) Opportunity: whether the program afforded them more opportunity; (5) Stress- whether implementation of program reduced usual levels of stress; (6) Work life- whether work life was enhanced as a result of the program; (7) Leave -- the number of nurses who left since the program was introduced was also evaluated (8) Valuable -- finally, the value of the program to the nurses was considered. (9) Team -- whether staff considered there to be a greater team spirit since program had been introduced (10) Information- whether communication / transmission of information had been enhanced as a result of the program.

Content validity would be estimated as 'adequate' according to the number of these factors incorporated in the final instrument. The fewer the number incorporated and tested, the lower would be the rating of content validity. I therefore aimed that at least three such factors indicating job satisfaction would be incorporated and tested.

Procedure for Data Collection

The staff group had started the Productive Ward Program in May 2011. The first set of questionnaires (Pre) had been implemented in May 2011 as baseline assessment before the nurses entered the Productive Mental Health Ward Initiative. The first three modules (Knowing How We Are Doing, Well Organized Ward and Patient Status At a Glance) had been implemented, as well as one selected process module in November 2011. All the frontline staff members from the final phase wards were given the questionnaire before we embarked the initiative (May 2011). Out of 112, I have received 100 responses back.

With the cooperation of the ward managers, I presented a presentation for each ward after soliciting the co-operation of the ward managers. The presentation consisted of * activities and conventional training tools in order to teach nurses more effective nursing care. The methods used were those developed in any industry setting and transplanted to the health care setting and these included actions such as using visual management so that ward items are easily located and retrieved; making medical information handed over more appropriate, easier to remember and easier to understand, and ensuring that medication times are patient centered and the self administration of medication is safe and reliable.

The training occurred for the duration of * a week (?) spread over * four, twenty minute sessions held during the afternoon at the same localities.

Ethical Consideration -- No ethical approval required ( Service Evaluation Study)

No ethical approval is required as it is the service evaluation audit. Since experimental research may involve isues intimidating and hurtful to a specific population as well as to particular individuals, or may include a vulnerable population (such as the eldelry or handicapped) or a specifically vulnerable age (such as infants), permission and certain complex coda need to be entered into in order to conduct that sort of research (Breakwell et al., 2007). In this case, hwoever, bias would need to be carefully controlled, as in the experimental study, but being that no ethical issues are involved, IRB forms need not be filled out nor study plumbed for potential ethical concernxs.

As regards, screening subjectivity, safeguards to avoid confounding effects include the following: I am using a purposeful sample and expecting the respondents providing some minimal but reliable qualitative information for some of the questions. I also will take safeguards to avoid subjectivity of the responses by analysing the data judiciously.