title: Associations between level of services integration and nurses' workplace well-being.
abstract: BACKGROUND
  To respond better to population needs, in recent years Quebec has invested in improving the integration of services and care pathways. Nurses are on the front lines of these transformation processes, which require them to adopt new clinical practices. This updating of practices can be a source of both satisfaction and stress. The aim of this study was to gain a better understanding of the relationship between the transformation processes underlying services integration and nurses' workplace well-being.
  
  
  METHODS
  This study was based on a descriptive cross-sectional correlational design. The target population included all nurses working in four care pathways in a Quebec healthcare establishment: palliative oncology services, mental health services, autonomy support for the elderly, and chronic obstructive pulmonary disease. In all, 107 nurses took part in the study and completed a questionnaire sent to them. Hierarchical linear regression analyses were used to examine the relationship between level of integration, measured using the Development Model for Integrated Care; nurses' perceptions of organizational change, measured on four dimensions (challenge, responsibility, threat, control); and nurses' workplace well-being, measured on three dimensions (negative stress, positive stress, satisfaction), as defined by the Flexihealth model.
  
  
  RESULTS
  Nurses in the palliative oncology care pathway, which was at a more advanced level of integration, presented a lower negative stress level and a higher positive stress level than did nurses in other care pathways. Their mean satisfaction score was also higher. More advanced integration was associated with nurses' feeling less threatened, as well as improved workplace well-being. The perception of threat appeared to be a significant mediating variable in the relationship between level of integration and well-being.
  
  
  CONCLUSIONS
  The association observed between level of services integration and workplace well-being contributes to a better understanding of nurses' experiences in such situations. These results provide new perspectives on interventions that could be implemented to remedy the potential negative consequences of these types of transformations.
authors.affiliation: Department of Nursing, University of Montreal. Centre for Training and Expertise in Nursing Administration Research (FERASI), Université du Québec en Outaouais, St-Jérôme Campus, 5 Saint-Joseph Street, Room 3212, Saint-Jérôme, Québec, J7Z 0B7 Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Longpré
authors.affiliation: University of Montreal, Montreal, Quebec Canada.
authors.forename: Carl-Ardy
authors.initials: CA
authors.lastname: Dubois
authors.affiliation: Department of Nursing, Université du Québec en Outaouais, St-Jérôme, Quebec, Canada.
authors.forename: Eric Tchouaket
authors.initials: ET
authors.lastname: Nguemeleu
keywords: Care and services integration processes; Nursing practice; Organizational and professional changes; Perceptions of change; Workplace well-being