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