The home care work environment's relationships with work engagement and burnout: A cross-sectional multi-centre study in Switzerland

Bridging Educational Grant in Nursing (BEGIN) students' intentions for retention in long-term, home and community care: A survey protocol

INTRODUCTION

Retention of nurses in long-term care (LTC) and home and community care (HCC) settings is a growing concern. Previous evidence underscores factors which contribute to nurses' intentions for retention in these sectors. However, perspectives of nursing students preparing to enter the workforce, and their intentions for short-term and long-term retention, remain unknown. This study aims to explore relationships between short-term and long-term intentions for retention with psychological empowerment, work engagement, career commitment, burnout, prosocial motivation, self-care and personal resilience among students enrolled in nursing educational bridging programs supported by the Bridging Educational Grant in Nursing (BEGIN) program in Ontario, Canada.

METHODS AND ANALYSIS

This cross-sectional design study will use an open online survey to investigate perspectives of current nursing students enrolled in educational bridging programs on factors relating to psychological empowerment, work engagement, career commitment, resilience, burnout, prosocial motivation, self-care and intentions for retention. Additionally, the survey will collect demographic information, including age, gender, ethnicity, citizenship, income, family status, nursing role, and years of employment and/or education. Open-ended questions will elicit participants' perspectives on financial considerations for career planning and other factors impacting intentions for retention. Descriptive data will be presented for contextualisation of participants' demographic characteristics to enhance generalisability of the cohort. Descriptive statistics will be used to summarise participants' scores on various assessment measures, as well as their short-term and long-term intentions for retention in LTC and HCC after completion of BEGIN. A Pearson's product moment r correlation will determine relationships between intentions for retention and other measures, and linear regression will determine whether any potential correlations can be explained by regression.

ETHICS AND DISSEMINATION

This research protocol received ethical approval from a research-intensive university research ethics board (#123211). Findings will be disseminated to nursing knowledge users in LTC and HCC through publications, conferences, social media and newsletters.

Research on Abuse in Home Care: A Scoping Review

Home care is the preferred care option for most people who need support; yet abuse exists in these settings toward both home care workers and clients. There are no existing reviews that assess the scope of current research on abuse in home care, and tangentially related reviews are dated. For these reasons, a scoping review is warranted to map the current state of research on abuse in home care and examine current interventions in this field. Databases selected for searching were Medline and EMBASE on OVID, Scopus, and the following databases in EBSCOhost: Academic Search Complete, AgeLine, and Cumulative Index to Nursing and Allied Health Literature. Records were included if: (a) they were written in English; (b) the participants were home care workers or clients age 18 years or older; (c) they were published in journals; (d) they undertook empirical research; and (e) they were published within the last 10-year period. Following Graham et al. (2006), the 52 included articles are categorized as either knowledge inquiry or as intervention studies. We find three themes among knowledge inquiry studies: (1) prevalence and types of abuse in home care, (2) abuse in the context of living with dementia, and (3) working conditions and abuse. Analysis from the intervention studies suggest that not all organizations have specific policies and practices to prevent abuse, and no existing interventions to protect the well-being of clients were identified. Findings from this review can inform up-to-date practice and policymaking to improve the health and well-being of home care clients and workers.

How does the distribution of work tasks among home care personnel relate to workload and health-related quality of life?

BACKGROUND

The work for Swedish home care workers is challenging with a variety of support and healthcare tasks for home care recipients. The aim of our study is to investigate how these tasks relate to workload and health-related quality of life among home care workers in Sweden. We also explore staff preferences concerning work distribution.

METHODS

A cross-sectional study was conducted in 16 municipalities in Northern Sweden. Questionnaires with validated instruments to measure workload (QPSNordic) and health-related quality of life (EQ-5D), were responded by 1154 (~ 58%) of approximately 2000 invited home care workers. EQ-5D responses were translated to a Quality-adjusted life-year (QALY) score. For 15 different work task areas, personnel provided their present and preferred allocation. Absolute risk differences were calculated with propensity score weighting.

RESULTS

Statistically significantly more or fewer problems differences were observed for: higher workloads were higher among those whose daily work included responding to personal alarms (8.4%), running errands outside the home (14%), rehabilitation (13%) and help with bathing (11%). Apart from rehabilitation, there were statistically significantly more (8-10%) problems with anxiety/depression for these tasks. QALY scores were lower among those whose daily work included food distribution (0.034) and higher for daily meal preparation (0.031), both explained by pain/discomfort dimension. Personnel preferred to, amongst other, spend less time responding to personal alarms, and more time providing social support.

CONCLUSION

The redistribution of work tasks is likely to reduce workload and improve the health of personnel. Our study provides an understanding of how such redistribution could be undertaken.

Work environmental factors associated with compassion satisfaction and end-of-life care quality among nurses in general wards, palliative care units, and home care settings: A cross-sectional survey

BACKGROUND

Nurses providing end-of-life care experience not only burnout and compassion fatigue, but also positive effects such as compassion satisfaction. Nurses' compassion satisfaction was shown to be related to job satisfaction, work engagement, and nurse caring. Studies in emergency departments, intensive care units, oncology wards, and general wards have identified work environmental factors associated with nurses' compassion satisfaction, but no similar studies have been conducted in palliative care units or home care settings. It is also unknown whether work environmental factors associated with compassion satisfaction contribute to end-of-life care quality.

OBJECTIVE

To explore work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality in three types of workplaces: general wards, palliative care units, and home care settings.

DESIGN

A cross-sectional survey of nurses providing end-of-life care.

SETTINGS

Sixteen general wards, 14 palliative care units, and 25 home-visit nursing agencies in Japan.

PARTICIPANTS

There were 347 study participants: 95 nurses in general wards, 128 in palliative care units, and 124 in home care settings.

METHODS

Compassion satisfaction was assessed using the Professional Quality of Life Scale, and end-of-life care quality was rated on a 4-point scale. Work environments were assessed using the Areas of Worklife Survey, which measures the fit between an individual and their work environment in six areas: workload, control, reward, community, fairness, and values.

RESULTS

Compared to nurses in general wards and palliative care units, home care nurses scored statistically significantly higher on all work environmental factors except reward. Work environmental factors that were significantly positively associated with higher compassion satisfaction were values in general wards (β = 0.335, P = 0.007), reward and workload in palliative care units (β = 0.266, P = 0.009 and β = 0.179, P = 0.035), and community and control in home care settings (β = 0.325, P = 0.001 and β = 0.261, P = 0.004). In addition, higher scores for workload in general wards (odds ratio = 5.321; 95 % confidence interval, 1.688-16.775) and for community in palliative units (odds ratio = 2.872; 95 % confidence interval, 1.161-7.102) were associated with higher end-of-life care quality. No associated work environmental factors were found in home care settings.

CONCLUSIONS

Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality varied between workplaces. These results may contribute to creating work environments that are appropriate for each workplace type to maintain both nurses' compassion satisfaction and end-of-life care quality.

TWEETABLE ABSTRACT

Work environmental factors associated with nurses' compassion satisfaction and end-of-life care quality were identified in three workplaces.

Aide and Client Safety "Should Go Hand-In-Hand": Qualitative Findings From Home Care Aides, Clients, and Agency Leaders

Retention of the home care (HC) aide workforce is essential to meet the needs of our aging population. Some studies suggest that improving HC safety could increase job retention. This study objective was to explore qualitatively the connection between aide and client safety and factors impacting this care relationship. Data consisted of audio-recorded, verbatim responses to open-ended questions of two focus groups with aides (n = 10), two in-person interviews with HC agency managers, and 37 phone interviews with those working in (aides, n = 16; managers, n = 12) and receiving (clients, n = 9) HC. Clients reported home layout and accessibility as safety concerns. Aides and managers reported that client family members can make the care job more challenging. The aide-client connection was affected by communication style, family and HC agency support, allotted care time, and job task boundaries. Interventions that address the safety of both clients and aides can influence HC job satisfaction and retention.

How to Address the Health of Home Care Workers: A Systematic Review of the Last Two Decades

Making home care a healthy workplace is a societal concern but research on specific interventions is still scarce. The aim of this systematic review was to provide an initial overview of interventions addressing home care workers' health. All (quasi-) experimental studies, presenting any intervention among home care employees, and reporting any outcome related to occupational health, safety, or well-being were included. PsycArticles, Medline, PubMed, and Web of Science were searched from January 2000 to February 2022. From 16,345 publications, 18 studies with 2432 participants were included and assessed with the Joanna Briggs Institute Critical Appraisal Tools. Organizational and training/educational approaches were found in five studies each, a behavioral approach in one, and seven studies presented a combined approach. Due to methodological limitations and the heterogeneity of interventions, the existing studies are insufficient to inform new programs, but emphasize the need for tailored approaches, integrated concepts, and participatory intervention development.

Shift work disorder, mental health and burnout among nurses: A cross-sectional study

AIM

The aim of the study was to examine the relationships among nurses' shift work disorder, mental health and burnout to inform efforts to alleviate shift work disorder.

DESIGN

This cross-sectional study was conducted in China using a web-based platform for questionnaire.

METHODS

The study was comprised of a convenience sample of 1,268 Registered Nurses from 21 public hospitals in mainland China from June 2019-July 2019. Participants completed a web-based survey designed to collect demographic and other self-reported data. An independent sample t test and Pearson correlation were performed to analyse the relationship between shift work disorder, mental health and burnout.

RESULTS

The vast majority (98.2%) of the participants were women between the ages of 20-59 years. The participants exhibited a higher incidence of mental health problems (58.1%) and burnout (65.5%) and those with shift work disorder exhibited a higher risk of mental health problems and burnout than those who did not have shift work disorder. Our research demonstrated that shift work disorder, combined with other variables, accounted for 40.5% of the variance in mental health (R²  = .405, adjusted R²  = .401, F = 107.214, p < .001) and 36.5% in burnout (R²  = .365, adjusted R²  = .361, F = 90.323, p < .001). Moreover, burnout negatively regulated the relationship between shift work disorder and mental health.

CONCLUSION

High-risk nurses with shift work disorder were at a much higher risk of mental health problems and burnout.

Nurses' emotional exhaustion: Prevalence, psychosocial risk factors and association to sick leave depending on care setting-A quantitative secondary analysis

AIMS

To explore differences in the prevalence, psychosocial risk factors and the connection to annual sick leave of nurses' emotional exhaustion depending on the care setting.

DESIGN

Quantitative study.

METHODS

We conducted a secondary data analysis of a cross-sectional, representative survey with German nurses (BIBB/BAuA-Employment Survey 2018). We analysed data from three groups of nurses (hospital care HC: n = 333, nursing homes NH: n = 143, home health care HHC: n = 109). We calculated prevalence estimates for all psychosocial risk factors and emotional exhaustion and utilized Χ² -tests to explore differences relating to the care setting. We calculated risk estimates using logistic regression analyses.

RESULTS

Forty-four per cent of all nurses reported symptoms of emotional exhaustion. Care settings did not affect prevalence estimates (HC: 45.3%, NH: 37.8%, HHC: 50.5%). Weekend work was a risk factor for exhaustion. Being at the limit of efficiency was the only work-related psychosocial risk factor being independent of the care setting. Emotional demands were a significant risk factor for nurses working in HC and NH, and low team cooperation was a risk factor for nurses working in NH. Nurses' emotional exhaustion is associated with more sick leave days.

CONCLUSIONS

The high prevalence of nurses' emotional exhaustion is independent of the care setting. This threatens nurses' health and negatively affects the organization and society due to the relation to sick leave. Weekend work and quantitative demands relate to exhaustion independently of the care context. Emotional demands and low team cooperation show context-specific correlations.

IMPACT

Organizational interventions that limit quantitative demands are needed to prevent exhaustion among nurses. In HC and NH, measures are needed to improve coping with emotional demands and to strengthen team cooperation. Policymakers and nursing managers should take action to address nurses' emotional exhaustion.

NO PATIENT OR PUBLIC CONTRIBUTION

Due to the study design.

Factors in the psychosocial work environment of staff are associated with satisfaction with care among older persons receiving home care services

Older persons in Sweden are increasingly encouraged to continue living at home and, if necessary, be supported by home care services (HCS). Studies have examined whether the work environment of staff has an impact on the experiences and well-being of older persons in residential care facilities, but few have examined such associations in HCS. This study examined associations between home care staff's perceptions of their psychosocial work environment and satisfaction with care among older people receiving HCS. The setting was 16 HCS work units. Two surveys were conducted, one on psychosocial working conditions of staff, one on satisfaction of older persons receiving HCS. For each work unit, data on individual satisfaction were matched to average values concerning psychosocial work conditions. Outcomes analysed with linear regressions were overall satisfaction and indices regarding assessment of performance of services, contact with staff and sense of security. The index for treatment by staff was analysed with ordered logistic regressions. Cluster correlated-standard error clustering on work units was used. Results showed that good working conditions were important for satisfaction with care, specifically overall satisfaction, treatment by staff and sense of security. The most important psychosocial work factors were work group climate, sense of mastery, job control, overall job strain, frustrated empathy, balancing competing needs, balancing emotional involvement and lack of recognition. Receiving more HCS hours was associated with stronger relationships between working conditions and satisfaction with care, especially with overall satisfaction and treatment by staff as outcomes. Managers and policymakers for home care need to acknowledge that the working conditions of home care staff are crucial for the satisfaction of older persons receiving HCS, particularly those receiving many HCS hours. Psychosocial work factors together with job strain factors are areas to focus on in order to improve working conditions for staff and outcomes for older persons.

Determinants of violence towards care workers working in the home setting: A systematic review

Background

Home care is a rapidly growing industry. Violence towards home care workers is common, while also likely underreported. This violence adversely affects the physical and mental health of both workers and care recipients. The current study aims to identify and appraise recent evidence on the determinants of violence towards care workers working in the home setting.

Methods

Six electronic databases: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Informit, Medline, PsycINFO, and Web of Science, were systematically searched. A systematic review was conducted in accordance with the Joanna Briggs Institute manual for evidence synthesis.

Results

A total of 18 papers met the inclusion criteria. All were cross‐sectional surveys. The majority of studies were from the United States. The most commonly investigated associations were those between the medical history of clients, workers' apprehension of violence, worker‐client relationship, or care plans, and any form of violence or verbal abuse.

Conclusion

Violence was common in clients with cognitive disorders, substance abuse disorder, and limited mobility; toward workers who feared that violence might happen; toward those who had very close or very distant worker‐client relationships; and when care plans were not inclusive of clients' needs. The current review highlights a gap in evidence on determinants of violence towards care workers working in the home setting, and suggests potential areas to be addressed to reduce such violence.

Tensions between infection control regulations and the home care working environment: An interview study with health care providers early during the COVID-19 pandemic

Background:

Therefore, the objective of this study was to elucidate caregivers’ experiences of ordinary homes as a working environment in home care and home health care during the COVID-19 pandemic. At the beginning of the pandemic, hospital care was in focus and the care of older adults was criticized around the world.

Design and methods:

Semi-structured qualitative interviews were conducted in two municipalities in Sweden between March 2020 and May 2021. One large municipality (population 155,000) with experience of care recipients with COVID-19, and a smaller municipality (population 32,000) were included; both had a focus on preventing the spread of the infection. A total of 27 participants working in home care were interviewed; these were occupational therapists, physical therapists, nurses, and assistant nurses. The interview material was analyzed using content analysis.

Results:

The interviews provided a comprehensive insight into the complex work environment in municipal home care during the pandemic. The staff had to deal with constantly changing information and new guidelines. They were also given new tasks and work routines that demanded more planning and were time-consuming. The staff experienced higher workload and pressure during the pandemic and did not have enough time to recover.

Conclusions:

During a pandemic situation, the information must be comprehensive and gathered in one place, and the managers must ensure sufficient staffing levels, time for reflection, and support for prioritization. The managers must also ensure the mental health of staff and meet their needs for recovery, both at and outside work.

Burnout and intention to leave among care workers in residential care homes in Hong Kong: Technology acceptance as a moderator

Care workers in residential care settings for older adults often experience job burnout, resulting in a high turnover rate. Previous studies offered contradictory findings on technology use in the workplace and its relationship with burnout. This study aimed to explore the moderator role technology acceptance plays in the relationship between burnout and intention to leave among care workers in residential care settings in Hong Kong. The study was based on a multicenter, cross-sectional questionnaire survey. The acceptance of general, and three specific, technologies (i.e., tablets, social robots and video gaming) was measured based on the scale of the Technology Acceptance Model. Two dimensions of burnout (exhaustion and disengagement) were measured using the Oldenburg Burnout Inventory scale. Intention to leave was measured using a self-reported item. Data collection took place from July to December 2018. We analysed data from 370 care workers from seven non-private residential care homes for older people in Hong Kong. A hierarchical multiple regression approach was used for moderator analysis. The results revealed that two measures of burnout (exhaustion and disengagement) were significantly and positively associated with intention to leave. The four measures of technology acceptance were negatively associated with intention to leave. The interaction of video-gaming acceptance and exhaustion was predictive of intention to leave (standardized beta = -0.20, p = .011). Acceptance of video gaming changed the strength of the relationship between exhaustion and intention to leave among participants. No significant moderating effects were observed in the relationship between disengagement and intention to leave. We highlight the importance of integrating technology variables, especially subjective appraisal of technology, in the issues of burnout and intention to leave. These findings shed new light on policies and practices that consider implement technology in routine care in residential care settings without unanticipated negative impacts for care staff.