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Armant A, Ollierou F, Gauvin J, Jeoffrion C, Cougot B, Waelli M, Moret L, Beauvivre K, Fleury-Bahi G, Berrut G, Tripodi D. Psychosocial and Organizational Processes and Determinants of Health Care Workers' (HCW) Health at Work in French Public EHPAD (Assisted Living Residences): A Qualitative Approach Using Grounded Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147286. [PMID: 34299739 PMCID: PMC8304826 DOI: 10.3390/ijerph18147286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/22/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Abstract
In a context marked by negative health indicators that make structural aspects more salient, this paper aimed at understanding and explaining the processes and determinants at work that positively and negatively interfere with the professionals’ health in the French public nursing home environment. To this purpose, the qualitative approach by grounded theory was chosen. In total, 90 semi-structured interviews were recorded and 43 were transcribed; in addition, 10 observations of 46 participations in meetings and working groups were carried out in four public service and hospital establishments. Our results indicate that the role of health workers, its definition, and its execution are fundamental to the understanding of their health at work. Two protective and constructive processes are involved in the maintenance and development of the professionals’ health in this work, with considerable confrontations with death and suffering: individual and collective control of emotional and cognitive commitment, and the development of resources for formation, information, and cooperation. Nonetheless, they are jeopardized when a lasting imbalance is generated between the work’s demands and the available resources. This leads to a loss spiral in organizational, inter-individual, and individual resources that makes it difficult to sustain work.
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Affiliation(s)
- Anne Armant
- Work and Health Innovation Research Laboratory, Department of Occupational Medicine and Environmental Health, Nantes University Hospital, F 44093 Nantes, France; (A.A.); (F.O.); (J.G.); (B.C.); (K.B.)
- Laboratoire de Psychologie des Pays de la Loire LPPL-EA 4638, Department of Psychology, University of Nantes, F 44000 Nantes, France;
| | - Florian Ollierou
- Work and Health Innovation Research Laboratory, Department of Occupational Medicine and Environmental Health, Nantes University Hospital, F 44093 Nantes, France; (A.A.); (F.O.); (J.G.); (B.C.); (K.B.)
| | - Jules Gauvin
- Work and Health Innovation Research Laboratory, Department of Occupational Medicine and Environmental Health, Nantes University Hospital, F 44093 Nantes, France; (A.A.); (F.O.); (J.G.); (B.C.); (K.B.)
| | - Christine Jeoffrion
- Laboratoire Inter-Universitaire de Psychologie, Personnalité, Cognition et Changement Social LIP/PC2S—EA 4145, Université of Grenoble Alpes, F 38058 Grenoble, France;
| | - Baptiste Cougot
- Work and Health Innovation Research Laboratory, Department of Occupational Medicine and Environmental Health, Nantes University Hospital, F 44093 Nantes, France; (A.A.); (F.O.); (J.G.); (B.C.); (K.B.)
- Qualité de Vie et Santé Psychologique (QualiPsy) EE1901, UFR Arts et Sciences Humaines, University of Tours, F 37000 Tours, France
| | - Mathias Waelli
- Management des Organisation en Santé MOS, EA 7348, Ecole des Hautes Etudes en Santé Publique EHESP, F 35043 Rennes, France;
| | - Leila Moret
- Methods in Patients-Centered Outcomes and Health Research-SPHERE, UMR INSERM U 1246–EA 4275, 22 Bd Bénoni Goullin, University of Nantes, F 42200 Nantes, France;
| | - Kristina Beauvivre
- Work and Health Innovation Research Laboratory, Department of Occupational Medicine and Environmental Health, Nantes University Hospital, F 44093 Nantes, France; (A.A.); (F.O.); (J.G.); (B.C.); (K.B.)
- Laboratoire de Psychologie des Pays de la Loire LPPL-EA 4638, Department of Psychology, University of Nantes, F 44000 Nantes, France;
| | - Ghozlane Fleury-Bahi
- Laboratoire de Psychologie des Pays de la Loire LPPL-EA 4638, Department of Psychology, University of Nantes, F 44000 Nantes, France;
| | - Gilles Berrut
- Gerontology Department, Pôle Hospitalo-Universitaire Gérontologie, Nantes University Hospital, F 44093 Nantes, France;
| | - Dominique Tripodi
- Work and Health Innovation Research Laboratory, Department of Occupational Medicine and Environmental Health, Nantes University Hospital, F 44093 Nantes, France; (A.A.); (F.O.); (J.G.); (B.C.); (K.B.)
- Laboratoire de Psychologie des Pays de la Loire LPPL-EA 4638, Department of Psychology, University of Nantes, F 44000 Nantes, France;
- Correspondence:
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López J, Pérez-Rojo G, Noriega C, Velasco C. Personal and Work-Related Factors Associated with Good Care for Institutionalized Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020820. [PMID: 33477928 PMCID: PMC7833360 DOI: 10.3390/ijerph18020820] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 01/23/2023]
Abstract
Despite efforts to promote good care, many institutionalized older adults (IOA) experience elevated neglectful conditions and reduced person-centered care approaches. Based on the job demand–control model, this study aimed to analyze the relationship between nursing home professionals’ personal and organizational factors and good care provided to institutionalized older people. Data was collected through a self-administered survey completed by 208 nursing home staff members. Three dimensions of personal factors (i.e., personal accomplishment, depersonalization, and negative old age stereotypes) were significant predictors of good care. Depersonalization and negative old age stereotypes were negatively associated with IOA, and both good care and personal accomplishment were positively associated with good care in nursing homes. Only one work-related factor (i.e., management support) was positively associated with good care. Personal factors may play a significant role in good care. Management support offers a promising mechanism to promote good care among nursing home professionals. The findings support the need to change the focus on entirely completing care tasks to providing good care of residents in nursing homes that promotes management support, personal accomplishment, personalization and positive old age consideration, attitudes, and behaviors. Policies and interventions should be developed to address in a more humanized way.
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Bowers B, Redsell SA. A qualitative study of community nurses' decision-making around the anticipatory prescribing of end-of-life medications. J Adv Nurs 2017; 73:2385-2394. [PMID: 28423478 DOI: 10.1111/jan.13319] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to explore community nurses' decision-making processes around the prescribing of anticipatory medications for people who are dying. BACKGROUND Community nurses frequently initiate the prescribing of anticipatory medications to help control symptoms in those who are dying. However, little is known about their decision-making processes in relation to when they instigate anticipatory prescribing and their discussions with families and General Practitioners. DESIGN A qualitative interpretive descriptive enquiry. METHODS A purposive sample of 11 Community Palliative Nurses and District Nurses working in one geographical area participated. Data were collected between March and June 2016 via audio recorded semi-structured interviews and analysed inductively using Braun and Clarke's thematic analysis. RESULTS Three themes were identified: (1) Drugs as a safety net. Anticipatory medications give nurses a sense of control in last days of life symptom management; (2) Reading the situation. The nurse judges when to introduce conversations around anticipatory medications, balancing the need for discussion with the dying person and their family's likely response; (3) Playing the game. The nurse owns the decision to initiate anticipatory medication prescribing and carefully negotiates with the General Practitioner. CONCLUSION Nurses view pain control through prescribed medication as key to symptom management for dying people. Consequently, they own the role of ascertaining when to initiate discussions with families about anticipatory medicines. Nurses believe they advocate for dying person and their families' needs and lead negotiations with General Practitioners for medications to go into the home. This nurse led care alters the traditional boundaries of the General Practitioners-nurse professional relationship.
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Affiliation(s)
- Ben Bowers
- Hinchingbrooke Health Care NHS Trust, Huntingdon, Cambridgeshire, UK
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Munck B, Sandgren A. The impact of medical technology on sense of security in the palliative home care setting. Br J Community Nurs 2017; 22:130-135. [PMID: 28252328 DOI: 10.12968/bjcn.2017.22.3.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The increase in the use of medical devices in palliative home care requires that patients and next-of-kin feel secure. Therefore, the aim was to describe medical technology's impact on the sense of security for patients, next-of-kin and district nurses. Deductive content analysis was conducted on data from three previous studies, using the theoretical framework 'palliative home care as a secure base'. The use of medical technology was shown to have an impact on the sense of security for all involved. A sense of control was promoted by trust in staff and their competence in managing the technology, which was linked to continuity. Inner peace and being in comfort implied effective symptom relief facilitated by pain pumps and being relieved of responsibility. Health care professionals need to have practical knowledge about medical technology, but at the same time have an awareness of how to create and maintain a sense of security.
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Affiliation(s)
- Berit Munck
- District Nurse, Senior Lecturer, Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
| | - Anna Sandgren
- Senior Lecturer, Co-director, Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Sweden
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Henoch I, Carlander I, Holm M, James I, Kenne Sarenmalm E, Lundh Hagelin C, Lind S, Sandgren A, Öhlén J. Palliative Care Research - A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012. Scand J Caring Sci 2015; 30:5-25. [DOI: 10.1111/scs.12253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Maja Holm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Inger James
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Elisabeth Kenne Sarenmalm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
| | - Carina Lundh Hagelin
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
- Research and Development Unit in Palliative care; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Susanne Lind
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Anna Sandgren
- School of Health Sciences; Jönköping University; Jönköping Sweden
- Center for Collaborative Palliative Care; Department of Health and Caring Sciences; Linneaus University; Kalmar/Växjö Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
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Thulesius HO, Scott H, Helgesson G, Lynöe N. De-tabooing dying control - a grounded theory study. BMC Palliat Care 2013; 12:13. [PMID: 23496849 PMCID: PMC3602181 DOI: 10.1186/1472-684x-12-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 02/26/2013] [Indexed: 11/23/2022] Open
Abstract
Background Dying is inescapable yet remains a neglected issue in modern health care. The research question in this study was “what is going on in the field of dying today?” What emerged was to eventually present a grounded theory of control of dying focusing specifically on how people react in relation to issues about euthanasia and physician-assisted suicide (PAS). Methods Classic grounded theory was used to analyze interviews with 55 laypersons and health care professionals in North America and Europe, surveys on attitudes to PAS among physicians and the Swedish general public, and scientific literature, North American discussion forum websites, and news sites. Results Open awareness of the nature and timing of a patient’s death became common in health care during the 1960s in the Western world. Open dying awareness contexts can be seen as the start of a weakening of a taboo towards controlled dying called de-tabooing. The growth of the hospice movement and palliative care, but also the legalization of euthanasia and PAS in the Benelux countries, and PAS in Montana, Oregon and Washington further represents de-tabooing dying control. An attitude positioning between the taboo of dying control and a growing taboo against questioning patient autonomy and self-determination called de-paternalizing is another aspect of de-tabooing. When confronted with a taboo, people first react emotionally based on “gut feelings” - emotional positioning. This is followed by reasoning and label wrestling using euphemisms and dysphemisms - reflective positioning. Rarely is de-tabooing unconditional but enabled by stipulated positioning as in soft laws (palliative care guidelines) and hard laws (euthanasia/PAS legislation). From a global perspective three shapes of dying control emerge. First, suboptimal palliative care in closed awareness contexts seen in Asian, Islamic and Latin cultures, called closed dying. Second, palliative care and sedation therapy, but not euthanasia or PAS, is seen in Europe and North America, called open dying with reversible medical control. Third, palliative care, sedation therapy, and PAS or euthanasia occurs together in the Benelux countries, Oregon, Washington and Montana, called open dying with irreversible medical control. Conclusions De-tabooing dying control is an assumed secular process starting with open awareness contexts of dying half a century ago, and continuing with the growth of the palliative care movement and later euthanasia and PAS legislation.
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Affiliation(s)
- Hans O Thulesius
- Department of Clinical Sciences Malmö, Division of Family Medicine, Lund University, Lund, Sweden.
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