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WORKLOAD of HOME HEALTH CARE NURSES in JAPAN By WORKLOAD OF HOME HEALTH CARE NURSES IN JAPAN by KEIKO OGAWA Submitted in partial fulfillment of the requirements For the degree of Doctor of Philosophy Dissertation Adviser: Dr. Elizabeth Madigan Frances Payne Bolton School of Nursing CASE WESTERN RESERVE UNIVERSITY May, 2008 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the theses/dissertation of KEIKO OGAWA Candidate for the PhD degree* (signed) Elizabeth Madigan (chair of the committee) Diana Morris Susan Tullai-McGuiness Robert Binstock (date) March 6, 2008 *We also certify that written approval has been obtained for any proprietary material contained therein. Copyright © 2008 by Keiko Ogawa All rights reserved i Table of Contents Page Table of Content------------------------------------------------------------------------------------ i List of Tables--------------------------------------------------------------------------------------- v List of Figures------------------------------------------------------------------------------------ -vii Acknowledgements-------------------------------------------------------------------------------viii Abstract----------------------------------------------------------------------------------------------ix CHAPTER I: Introduction ------------------------------------------------------------------------1 Introduction-----------------------------------------------------------------------------------------1 Problem and Significance Statements -----------------------------------------------------------2 Conceptual Framework----------------------------------------------------------------------------8 Concepts in the Present Study-----------------------------------------------------------9 Definition of Terms--------------------------------------------------------------------- 14 Research Questions ------------------------------------------------------------------------------ 14 Significance to Nursing Science and Practice------------------------------------------------ 15 Nursing Science ------------------------------------------------------------------------- 15 Nursing Practice------------------------------------------------------------------------- 16 CHAPTER II: Review of the Literature ------------------------------------------------------ 18 Job satisfaction ----------------------------------------------------------------------------------- 18 Job satisfaction -------------------------------------------------------------------------- 30 Relationship between job satisfaction and nurse characteristics------------------ 32 Productivity--------------------------------------------------------------------------------------- 33 Relationship between productivity and nurse characteristics --------------------- 34 ii Relationship between productivity and job satisfaction---------------------------- 35 Productivity ------------------------------------------------------------------------------ 35 Time spent in home-visit nursing care ----------------------------------------------- 41 Gaps in the literature----------------------------------------------------------------------------- 48 CHAPTER III: Methodology------------------------------------------------------------------- 52 Design --------------------------------------------------------------------------------------------- 52 Settings and Samples ---------------------------------------------------------------------------- 57 Sample Size and Power Analysis -------------------------------------------------------------- 58 Data Collection Procedure ---------------------------------------------------------------------- 59 Measurements ------------------------------------------------------------------------------------ 60 NWI-R------------------------------------------------------------------------------------ 60 Reliability and Validity----------------------------------------------------------------- 63 Statistical analysis ------------------------------------------------------------------------------- 65 Research Questions --------------------------------------------------------------------- 65 Protection of Human Subjects------------------------------------------------------------------ 67 Chapter IV: Results ------------------------------------------------------------------------------ 69 Recruitment--------------------------------------------------------------------------------------- 69 Sample Description ------------------------------------------------------------------------------ 70 Job Satisfaction----------------------------------------------------------------------------------- 74 Reliability and Validity ------------------------------------------------------------------------- 77 The NWI-R ------------------------------------------------------------------------------ 77 Analyses to Answer Research Questions ----------------------------------------------------- 77 Testing Assumption of Multiple Regression ---------------------------------------- 77 iii Research Question 1 -------------------------------------------------------------------- 78 Research Question 2 -------------------------------------------------------------------- 82 Research Question 3 -------------------------------------------------------------------- 86 Research Question 4 -------------------------------------------------------------------- 88 Research Question 5 -------------------------------------------------------------------- 89 Summary ------------------------------------------------------------------------------------------ 92 Chapter V: Discussion--------------------------------------------------------------------------- 94 Discussion of Results---------------------------------------------------------------------------- 94 The Relationships between Nurse Characteristics and Job Satisfaction --------- 94 Job Satisfaction-------------------------------------------------------------------------- 95 The Productivity of Japanese Visiting Nurses--------------------------------------- 100 The Relationships between Nurse Characteristics and Productivity-------------- 103 The Relationships between Productivity and Job Satisfaction -------------------- 104 The Relationships between Nurse Characteristics and Productivity, and Job Satisfaction------------------------------------------------------------------------------- 104 Implications for policy, theory and administration ------------------------------------------ 105 Implication for policy------------------------------------------------------------------- 105 Implication for theory ------------------------------------------------------------------ 107 Implication for administration--------------------------------------------------------- 108 Limitations---------------------------------------------------------------------------------------- 108 Suggestions for future research ---------------------------------------------------------------- 109 Summary ------------------------------------------------------------------------------------------ 110 APPENDIX A: Nurse Workload Form ------------------------------------------------------- 113 iv APPENDIX B: Nurse Questionnaire ---------------------------------------------------------- 120 APPENDIX C: Study Variables --------------------------------------------------------------- 122 APPENDIX D: Cover Letter ------------------------------------------------------------------- 125 APPENDIX E: A letter of cooperation-------------------------------------------------------- 126 APPENDIX F: Cover Letter-------------------------------------------------------------------- 127 APPENDIX G: Informed Consent Document------------------------------------------------ 128 BIBLIOGRAPHY ------------------------------------------------------------------------------- 130 v List of Tables Table 1: A summary of the relevant research: Job satisfaction and nurse characteristics---------------------------------------- 20 Table 2: A summary of the relevant research: Productivity and nurse characteristics ------------------------------------------- 34 Table 3: Example of calculating productivity by Power’s (1987) formulas----------- 40 Table 4: A summary of the relevant research: Time spent in home-visit nursing care------------------------------------------- 42 Table 5: A summary of the relevant research: Research design ------------------------ 53 Table6: Sample Characteristics: Age and Years of Experience--------------------------71 Table7: Age Distribution----------------------------------------------------------------------72 Table8: Sample Characteristics: Gender, Employment status, and Education---------73 Table9: Job Satisfaction (The NWI-R and the overall job satisfaction) ----------------76 Table10: Correlation of nurse characteristics with job satisfaction (the NWI-R)-------80 Table11: Correlation of nurse characteristics with job satisfaction (the overall job satisfaction) ----------------------------------------------------------------------------80 Table12: Regression Analysis for Variables predicting job satisfaction (the NWI-R)---81 Table13:Regression Analysis for Variables predicting job satisfaction (the overall job satisfaction)----------------------------------------------------------------------------81 Table14: Workload (total hours, visits number, and working days)----------------------83 Table15: Workload (Type of visits)-----------------------------------------------------------83 Table16: Workload (care time minutes)------------------------------------------------------84 Table17: Productivity
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