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all requirements in PDF files and photoThere is PDF files with questions must be solved, and other question in the photo and all must be solved correctly.word counts depends on each questions. similarity must be less than 5\%Turintin report is needed photo_2020_05_20_16_44_54.jpg _______________________.pdf ruqaya.pdf Unformatted Attachment Preview Oman College of Health Science Al Dakhiliya Branch Nursing Research Final Assignment Part 2 Instruction Year II-Semester II Academic Year 2019-2020  General Guidelines of the Assignment  Paper should be type font time New Roman, Size 12  Title page should include students full name, data of submission, name of the teacher, the title of the topic and specify part 2 of the assignment and should include header  Spelling and grammar mistakes are considered  APA reference style should be followed A  Space should be double space  Paper should be organized and net  Assignment should be submitted in 21st May, 2020 at 11:59PM  Students are not allowed to ask questions since this is a final exam  Rubric of the paper correction is provided  The assignment is worth 25\% of course mark Specific Instruction In the attached research article answer the following questions: 1. Read the abstract and introduction of your attached study and answer the relevant question from box 1.1 on page 15 in you research text book In addition answer the following questions 2. What Level of evidence is this study? You can refer to your text book page 23? Explain your answer? 3. State the component of the research question (PIO) in the study? 4. What data collection did the researcher used to collect their data? 5. Could this study have been undertaken in a different research approach? Why or why not? 6. Is there is a funding agency for this study? If yes who fund the research? 7. What gap in the existing research was the study designed to fill? Prepared by: Dr. Zaina Al Harmali Course Coordinator . . . . . Rural Hospitals . . . . . Improving Work Environment Perceptions for Nurses Employed in a Rural Setting Susan L. Teasley, RN;1 Kathleen A. Sexton, RN, BSN, MA;1 Cathryn A. Carroll, PhD;1 Karen S. Cox, PhD, RN, FAAN;1,2 Michele Riley RN, MSN;3 and Kathleen Ferriell RN, MSN3 hospitals approximately 60\% longer than urban facilities to fill nursing vacancies.2 In addition, the current demographics of the rural nursing workforce are such that a large percentage of the staff may choose retirement within the next decade. The large number of vacancies caused by voluntary retirement may challenge rural hospitals as they seek to recruit and retain younger nursing professionals to nonurban areas. The recruitment of new nurses to fill vacancies may be particularly challenging given the lower salaries that have been reported to exist in rural institutions.3 Furthermore, rural facilities frequently have fewer resources to support the needs of nurses working on the evening shift.4,5 On the positive side, evidence suggests that nursing practice in rural areas has its advantages. According to a report, nurse staffing per occupied beds in rural hospitals was greater than staffing levels in urban institutions.6 In addition, other research suggests that job satisfaction for rural nurses can be greater than that reported by urban nurses, particularly with respect to professional status, task requirements, organizational policies, and autonomy.3 With the exception of pay, the results indicated that nurses employed in very small rural hospitals are more satisfied with their jobs.3 The effectiveness of any organization is contingent upon its ability to recruit and retain high-quality staff. This is certainly true for rural health care organizations.7 Ensuring a stable nursing workforce continues to be a priority area for nursing leadership in all facilities regardless of their size. This article ABSTRACT: Context: Effective recruitment and retention of professional nurses is a survival strategy for health care facilities, especially in rural areas. Purpose: This study examines the use of the Individual Workload Perception Scale to measure nurse satisfaction by a small rural hospital in order to make positive changes in the work environment for nurses. Methods: Baseline work environment perceptions of nurses employed in a rural Kentucky hospital were assessed using the Individual Workload Perception Scale, a validated 38-item instrument. Nurses reviewed the results and brainstormed on potential interventions to address areas of concern. The 4 interventions selected for implementation by the nursing staff included (1) implementation of a shared decision making or governance model; (2) enhanced role of licensed practical nurses within the organization; (3) augmentation of administrative support on night and weekend shifts; and (4) utilization of wireless communication devices. After implementation of the interventions, staff nurse perceptions were reassessed using the same tool. Findings: The follow-up survey revealed improvements in all areas measured by the Individual Workload Perception Scale, with the greatest improvement in the perception of the work environment noted among night nurses. The increase in positive work environment perception among these nurses, with greater than or equal to 11 years of professional experience, was statistically significant. Conclusions: Tools exist to support the development and evaluation of interventions to improve the work environment for nurses practicing in rural health care settings. By addressing issues of specific concern, both job satisfaction and retention of this talented pool of professionals can be enhanced. P 1 Patient Care Services, Children’s Mercy Hospitals and Clinics, Kansas City, MO. 2 School of Nursing, University of Missouri—Kansas City, Kansas City MO. 3 Department of Nursing, Spring View Hospital, Lebanon, KY. rior research suggests that rural hospitals may be unique in their nursing workforce issues.1 MacPhee and Scott reported in 2002 that recruitment in rural facilities can be problematic as it frequently takes rural © 2007 National Rural Health Association For further information, contact: Kathleen A. Sexton, RN, BSN, MA, Patient Care Services, Children’s Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108; e-mail ksexton@cmh.edu. 179 Spring 2007 . . . . . Rural Hospitals . . . . . describes how one rural hospital developed a system by which nurse perceptions of the work environment could be evaluated and enhanced, thereby serving as a tool to support retention of nurses within that institution. Specifically, the goals of the project were to (1) use nursing staff input to identify interventions that may improve the nursing work environment and (2) assess nurse perceptions before and after the adoption of these interventions to see if the desired results were obtained. peer support, and perceived workload. In addition, nurses’ responses signal their intent to stay within the organization for at least the 12 months. An aggregate measure of overall nursing satisfaction can be computed using an average of the other domain scores. The psychometric properties (validity and reliability) of the IWPS, as tested in a sample of over 800 pediatric nurses, are described elsewhere.9 Internal consistency has been demonstrated with the instrument, with Cronbach’s alphas ranging from 0.66 to 0.92.9 The proven consistency of the tool motivated the primary selection of this instrument over other tools to assess nurse perceptions of the work environment. Also, the tool is short and can be completed without substantial time commitments on the part of nursing staff. In general, higher responses on the IWPS are indicative of more positive perceptions of the work environment across all domains. Methods Spring View Hospital is a 75-bed facility in a rural Kentucky community of approximately 5,000, located about 60 miles from any major metropolitan area. The study population included a convenience sample of nurses in the hospital. After approval by a human subjects review committee, nurses across all practice settings and shifts were allowed to participate if they wished. Enrollment in the study was encouraged by the organization’s nursing leadership. Baseline data collection occurred in 2003 with a sample of 31 nurses and was repeated following implementation of study interventions in December 2004, using a second sample of 36 nurses. The respondents in the baseline and follow-up surveys were not all the same individuals. Data specific to nurse perceptions of the work environment before and after the interventions were collected using the Individual Workload Perception Scale (IWPS) and analyzed using SPSS version 12.0 (SPSS Inc., Chicago, Ill). Equipped with the results of the baseline assessment, nursing leadership asked the nursing staff to participate in meetings that generated and prioritized a list of interventions for implementation (these are described in the Results section). After the implementation of the intervention program, a second assessment of nurses’ perceptions of the work environment was conducted using the IWPS. Thirty-six nurses agreed to participate in the postevaluation survey. Data analysis was carried out, and changes in nurse perceptions from baseline were reported to nursing leadership at Spring View for their consideration. Individual Workload Perception Scale. Nurses provided data specific to their perceptions of key characteristics of the work environment through the completion of the IWPS.8 The IWPS is a validated tool, with responses provided on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The instrument measures nurse self-reported perceptions of key characteristics of the work environment, including manager support, unit support, The Journal of Rural Health Results The 4 strategies chosen for implementation, based on nursing staff feedback gained through the baseline IWPS and nursing staff meetings, included (1) a shared decision making or governance model; (2) enhanced role of licensed practical nurses (LPNs) within the organization; (3) augmentation of administrative support on night and weekend shifts; and (4) utilization of wireless communication devices. These interventions cost about $225,000 to implement. The first intervention was the development of a nursing specific decision-making body, known as the Patient Care Council, to discuss and address important patient care issues through policy and protocol revisions. In addition, this group developed standardized policies for employee tenure, seniority for job selection, and absenteeism. These initiatives fueled staff participation in the shared governance model as a means of making differences in the nursing practice and work environment at Spring View Hospital. The adoption of the shared governance model occurred without additional economic burden on the facility beyond those costs of educating staff on the role members are expected to play in this type of governance model. The second intervention adopted by the organization focused on staffing issues. Although the LPN has a more limited scope of practice than the registered nurse, LPNs are more readily available in rural communities so frequently faced with nursing shortages.10,11 In addition, LPNs can alleviate staffing issues that occur because of census fluctuations.12 Another benefit of the increased utilization of the LPN is that it permits nurses with other skill sets to coordinate care and evaluate outcomes. 180 Vol. 23, No. 2 . . . . . Rural Hospitals . . . . . The third intervention focused on ensuring adequate managerial support for staff 24 hours per day. Nursing house supervisor positions were added to both the night and weekend shifts to provide staffing support, clinical guidance, and administrative oversight. Prior to this time, the emergency room charge nurses maintained a dual function of “Staff Advisors” in addition to their staff nurse and administrative liaison responsibilities. The final intervention focused on the use of wireless technology to foster efficient communication between key stakeholders within the organization. Wireless phone systems were piloted to see if communication between nurses at the bedside and physicians, ancillary staff, family members, and others could be enhanced. The results of the pilot program were positive, as assessed by a separate questionnaire (not the follow-up IWPS), so the wireless phone system was implemented strategically within the facility. Responses to the follow-up IWPS suggested that adoption of this multifactor strategic interventional program designed through the input of nursing staff was successful in improving nurse work environment perceptions, self-reported intent to stay, and overall nursing satisfaction. The greatest improvement in nurse perceptions occurred in the workload and intent to stay domain. Statistically significant improved perceptions of workload were reported for registered nurses and individuals with more than 11 years in nursing. Interestingly, nurses working on the night shift appeared to report greater improvements in perceptions of their work environment than their colleagues working on the day shift (Table). The lowest level of improvement occurred in the unit support domain, which might be intuitive as the intervention was designed and primarily focused on nursing roles and not assistance by ancillary personnel. Improvements in manager and peer support were also observed but not to the same degree as the improvements seen in the nurse perceptions of their workload. Comparison of Mean IWPS Scores* by Work Shift (Day/Night) of Respondent IWPS Domains Manager support Day shift Night shift Peer support Day shift Night shift Unit support Day shift Night shift Workload Day shift Night shift Intent to stay Day shift Night shift Nurse satisfaction Day shift Night shift Posttest, Days (n = 25), Nights (n = 11) 3.83 2.74 3.29 3.86 NS† P < .003 4.10 3.52 3.88 4.23 NS P < .010 3.72 3.18 3.30 4.00 NS P < .001 3.47 2.90 3.47 3.90 NS P < .004 3.77 2.77 3.40 4.28 NS P < .002 3.88 3.05 3.47 4.04 NS P < .000 * The IWPS includes multiple items within the work environment domains of manager support, unit support, peer support, and perceived workload. Aggregate measures for the domains are presented here. Averages are based on a 1-5 Likert scale, with 5 being the most positive response. † Not significant. the responsibility of nursing leadership to provide a positive work environment for rural nurses. Significant improvements in work environment perceptions for nursing were observed on the night shift, which may reflect the increase in managerial support provided to night and weekend staff as well as the improved communication that was facilitated through technology. As such, the needs of all nurses working in the facility were covered 24 hours a day.13 As with any investigation, limitations of this study exist. First, the recruitment for study participation was primarily driven by nursing leadership, which could bias results. Also, the study sample was small and within 1 institution, limiting the ability to generalize the findings. The convenience sampling methodology as well as the differences in the individual nurses participating in the pre- and postassessment may have influenced the findings. The limitations of this work and the dearth of literature specific to rural hospital nursing and work environment speak to the importance and need of future work in this area. Discussion Opportunities exist, irrespective of geographic location or facility size, to improve the working environment for nursing professionals. This article outlines an example of a simple method to assess nurse perceptions, design interventions based on the results obtained, and then reevaluate whether the desired programmatic goals were achieved. The motivation for this evaluation was the recognition that unique issues exist for the recruitment and retention of nurses working in rural hospitals. It is Teasley, et al. Pretest, Days (n = 16), Nights (n = 15) 181 Spring 2007 . . . . . Rural Hospitals . . . . . 3. Coward RT, Horne C, Duncan P, Dwyer JW. Job satisfaction among hospital nurses: facility size and location comparisons. J Rural Health. 1992;8:255-267. 4. Barton J. Choosing to work at night: a moderating influence on individual tolerance to shift work. J Appl Psychol. 1994;79:449-454. 5. Verhaegen P, Cober R, De Smedt M, et al. The adaptation of night nurses to different work schedules. Ergonomics. 1987;30:1301-1309. 6. Shullanberger G. Nurse staffing decisions: an integrative review of the literature. Nurs Econ. 2000;18:124-132, 146-148. 7. Peltier JW, Boyt T, Westfall J. Using relationship marketing to develop and sustain nurse loyalty: a case of a rural health care institution. J Health Hum Serv Adm. 1999;22:83-104. 8. Cox KS. Individual Work Environment Perception Scale User’s Manual. Kansas City, Mo: Children’s Mercy Hospitals and Clinics; 2003. 9. Cox KS, Teasley SL, Zeller RA, Lacey SR, Parsons L, Carroll CA, Ward-Smith PS. Know staff ’s “intent to stay.” Nurs Manage. 2006;37:13-15. 10. Spetz J. What should we expect from California’s minimum nurse staffing legislation? J Nurs Adm. 2001;31;132-140. 11. Stratton TD, Dunkin JW, Szigeti E, Muus KJ. Recruitment barriers in rural community hospitals: a comparison of nursing and nonnursing factors. Appl Nurs Res. 1998;11:183-189. 12. Berney B, Needleman J, Kovner C. Factors influencing the use of registered nurse overtime in hospitals. J Nurs Sch. 2005;37:165-173. 13. Brooks I. The lights are bright? Debating the future of the permanent night shift, J Manage Med. 1997;11:58. 14. Pan S, Dunkin J, Muus KJ, Harris R, Geller J. A logit analysis of the likelihood of leaving rural settings for registered nurses. J Rural Health 1995;11:106-113. Nevertheless, this small evaluation suggests that improving the work environment can improve overall satisfaction for nurses working in rural hospitals. Moreover, given the potential loss of experienced rural nurses in the near-term because of aging of the workforce, nursing leadership working in rural hospitals should seize the opportunity to improve workload for these individuals. A proactive strategy encouraging a healthy work environment for experienced rural nurses seems like a far more logical choice than enduring the lengthy delays in recruiting new nurses to fill vacancies. In this regard, our efforts support the findings from prior efforts that suggest that rural nursing administrators and policy makers should give priority to retention strategies that focus on improving the job environment within rural hospitals.14 References 1. Cox KS, Carroll CA, Sexton KA. Achieving magnet status: demonstrating nursing excellence Kans Nurse. 2005;80:1-2. 2. MacPhee M, Scott J. The role of social support networks for rural hospital nurses: supporting and sustaining the rural nursing work force. J Nurs Adm. 2002;32:264-272. The Journal of Rural Health 182 Vol. 23, No. 2 ... Purchase answer to see full attachment