Work satisfaction and dissatisfaction--caregivers' experiences after a two-year intervention in a newly opened nursing home

Deeply Discrediting: A Systematic Review Examining the Conceptualizations and Consequences of the Stigma of Working in Aged Care

BACKGROUND AND OBJECTIVES

The stigma of working in aged care can discredit and devalue those working in gerontology. This overlooked workforce issue may underpin complex staffing challenges like chronic worker shortages and inadequate care delivery. Our review synthesizes the existing literature and introduces a conceptual framework based on linguistics to reconcile disparate conceptualizations and negative consequences of this stigma.

RESEARCH DESIGN AND METHODS

We conducted a systematic review and assessed peer-reviewed articles published from 1973 to 2019 across 5 databases. Fifty-nine articles were selected based on criteria grounded in stigma theory.

RESULTS

Only 10 articles explicitly used the term "stigma" when conceptualizing the stigma of working in aged care. An additional 49 articles conceptualized this stigma in terms of stigma processes (e.g., status loss). Findings from a deeper examination using a linguistic analysis revealed societal groups predominantly conceptualized stigma in 3 distinct ways based on (a) unfavorable character judgment of aged care workers, (b) lower value placed on aged care work, and (c) negative emotional reactions towards working in aged care. Last, stigma was associated with adverse psychological and job-related consequences.

DISCUSSION AND IMPLICATIONS

Reconceptualizing this workforce issue and recognizing it as a societal challenge will enable policymakers to design evidence-based interventions at industry and societal levels. We propose workforce challenges in the aged care sector such as attraction, retention, and well-being may lessen with interventions aimed at mitigating the stigma of working in aged care.

Self-realisation-What does this mean for school nurses to remain in nursing practice?

AIMS AND OBJECTIVES

To describe and interpret what it means for school nurses to realise themselves so that they remain in nursing practice.

BACKGROUND

Self-realisation seems to influence on nurses remaining in nursing practice. School nurses report aspects (i.e. autonomy and professional development) which can be linked to self-realisation as important for themselves, but few studies describe what it means for school nurses to realise themselves so that they remain in practice.

DESIGN AND METHOD

This study used a qualitative design, conducting two individual in-depth interviews with 15 school nurses. The interviews were analysed with a phenomenological hermeneutic method. The COREQ checklist has been used in reporting this study.

RESULTS

The following themes were emerged: (a) being attentive to yourself, (b) acting true to yourself and (c) making independent choices.

CONCLUSION

This study offers insight into what it means for school nurses to realise themselves so that they remain in nursing practice, that is to practise their originality and take a stand for what they consider important. Self-realisation was embedded within nursing practice and consequently seems to impact on nurses remaining in practice.

RELEVANCE TO CLINICAL PRACTICE

Nurses who practise their originality and take a stand for what they identify as important realise self. This implies being themselves and practising nursing in a way they find relevant. Nursing leaders who encourage nurses to articulate what this entails facilitate their self-realisation. A clinical practice where nurses can be attentive and act true to themselves, and have opportunities to make independent choices, will be a practice where nurses can realise self. We suggest that clinical practice which emphasises opportunities for nurses' self-realisation may facilitate their remaining in practice.

Encountering Suffering at Work in Health Religious Organizations: A Partial Least Squares Path Modeling Case-Study

Health religious organizations tend to offer individual attention to patients in line with their spiritual character and, at the same time, the highest service quality. This study puts the attention on the nurse-patient relationship and empirically explores a theoretical model that links nurses’ suffering at work with personal’s willingness to engage in a therapeutic and spiritual relationship with patients and the consequent effect on quality. Data has been collected in the city of Madrid (Spain) in the month of June 2019 in Santa Elena Clinic. An analytical case-study based on Partial Least Squares (PLS) path modeling is the chosen method to verify the cause-effect hypothesized relationships. This study contributes to the current academic literature by providing new knowledge and empirical evidence on the topic of the future of work in health religious organizations. The main conclusion is the necessary inclusion of suffering, even in good places to work, as a key indicator for a better management. Results should be a useful source of information for practitioners that seek to implement better human management systems in these organizations.

Workplace-Based Organizational Interventions Promoting Mental Health and Happiness among Healthcare Workers: A Realist Review

Mental illness, deemed globally to account for 32% of years lived with a disability, generates significant impacts on workplaces. In particular, healthcare workers experience high rates of mental ill health such as burnout, stress, and depression due to workplace conditions including excessive workloads, workplace violence and bullying, which also produces negative effects on patients as well as on the happiness and wellbeing of those who remain at work. This review was undertaken to synthesize the evidence on workplace-based interventions at the organizational level promoting mental health and wellbeing among healthcare workers, to identify what has been receiving attention in this area and why, especially considering how such positive effects are produced. A search of three premier health-related databases identified 1290 articles that discussed healthcare workers, workplace interventions, and mental health. Following further examination, 46 articles were ultimately selected as meeting the criteria specifying interventions at the organizational level and combined with similar studies included in a relevant Cochrane review. The 60 chosen articles were then analyzed following a realist framework analyzing context, mechanism, and outcome. Most of the studies included in the realist review were conducted in high-income countries, and the types of organizational-level interventions studied included skills and knowledge development, leadership development, communication and team building, stress management as well as workload and time management. Common themes from the realist review highlight the importance of employee engagement in the intervention development and implementation process. The literature review also supports the recognized need for more research on mental health and happiness in low- and middle-income countries, and for studies evaluating the longer-term effects of workplace mental health promotion.

Experiences of Caregivers and Relatives in Public Nursing Homes

The aim of the present study was, by means of discussion highlighting ethical questions and moral reasonings, to increase understanding of the situations of caregivers and relatives of older persons living in a public nursing home in Sweden. The findings show that these circumstances can be better understood by considering two different perspectives: an individual perspective, which focuses on the direct contact that occurs among older people, caregivers and relatives; and a societal perspective, which focuses on the norms, values, rules and laws that govern a society. Relatives and caregivers thought that the politicians were sending out mixed messages: they were praising caregivers and relatives for their efforts, but at the same time the public health care sector was subjected to significant cutbacks in resources. Both caregivers and relatives were dissatisfied and frustrated with the present situation regarding the care of older persons in public nursing homes.

[Relationship between perceived emotional intelligence and professional quality of life with the achievement of occupational objectives in the costa del sol primary health care district]

Objetivo

Explorar la relación existente entre «calidad de vida profesional» e «inteligencia emocional percibida», y la relación de ambas con el grado de consecución de objetivos laborales en el Distrito de Atención Primaria Costa del Sol.

Diseño

Estudio observacional descriptivo transversal multicéntrico.

Emplazamiento

Distrito Sanitario Costa del Sol en la Provincia de Málaga.

Participantes

Muestra de profesionales de todas las categorías, fijos y contratados, de las Unidades de Gestión del Distrito Costa del Sol (n = 303). Respondieron 247 (81,5%).

Mediciones principales

Se recogieron los datos de porcentaje de consecución de objetivos del año 2010 y los datos sociodemográficos de los participantes; para ello se utilizaron cuestionarios autoadministrados diseñados ad hoc. Para medir la «inteligencia emocional percibida» y «calidad de vida profesional percibida», se utilizaron los cuestionarios TMMS-24 que mide las dimensiones: percepción, comprensión y regulación emocional y CVP-35 que mide las dimensiones: apoyo directivo, demanda de trabajo y motivación intrínseca.

Resultados

Se observaron correlaciones significativas entre calidad de vida profesional e inteligencia emocional en las categorías de regulación (p < 0,01) y comprensión (p < 0,05). También existían correlaciones significativas entre la profesión y tipo de contrato con la consecución de objetivos, (p < 0,005) y entre calidad de vida profesional y tipo de contrato (p < 0,05).

Conclusiones

La calidad de vida profesional percibida se relaciona con la percepción y la regulación como dimensiones de la inteligencia emocional. Desde los órganos de gestión se debe promover el conocimiento de métodos del manejo de las emociones en todos sus profesionales.

Complementary medicine in nursing homes--results of a mixed methods pilot study

BACKGROUND

'Kneipp Therapy' (KT) is a form of Complementary and Alternative Medicine (CAM) that includes a combination of hydrotherapy, herbal medicine, mind-body medicine, physical activities, and healthy eating. Since 2007, some nursing homes for older adults in Germany began to integrate CAM in the form of KT in care. The study investigated how KT is used in daily routine care and explored the health status of residents and caregivers involved in KT.

METHODS

We performed a cross-sectional pilot study with a mixed methods approach that collected both quantitative and qualitative data in four German nursing homes in 2011. Assessments in the quantitative component included the Quality of Life in Dementia (QUALIDEM), the Short Form 12 Health Survey (SF-12), the Barthel-Index for residents and the Work Ability Index (WAI) and SF-12 for caregivers. The qualitative component addressed the residents' and caregivers' subjectively experienced changes after integration of KT. It was conceptualized as an ethnographic rapid appraisal by conducting participant observation and semi-structured interviews in two of the four nursing homes.

RESULTS

The quantitative component included 64 residents (53 female, 83.2 ± 8.1 years (mean and SD)) and 29 caregivers (all female, 42.0 ± 11.7 years). Residents were multimorbid (8 ± 3 diagnoses), and activities of daily living were restricted (Barthel-Index 60.6 ± 24.4). The caregivers' results indicated good work ability (WAI 37.4 ± 5.1), health related quality of life was superior to the German sample (SF-12 physical CSS 49.2 ± 8.0; mental CSS 54.1 ± 6.6). Among both caregivers and residents, 89% considered KT to be positive for well-being.The qualitative analysis showed that caregivers perceived emotional and functional benefits from more content and calmer residents, a larger variety in basic care practices, and a more self-determined scope of action. Residents reported gains in attention and caring, and recognition of their lay knowledge.

CONCLUSION

Residents showed typical characteristics of nursing home inhabitants. Caregivers demonstrated good work ability. Both reported to have benefits from KT. The results provide a good basis for future projects, e.g. controlled studies to evaluate the effects of CAM in nursing homes.

Meanings over time of working as a nurse in elderly care

Background:

Although registered nurses (RNs) play a central role in the care of older persons, their work in elderly care has historically been described as “low status” in nursing. This is especially problematic due to the global issue of RN turnover, but there is still little evidence of how to change this trend. Better understanding is needed of the reasons why RNs work in elderly care, as well as knowledge of whether these reasons have changed over time.

Aim:

The aim was to explore the meaning of working in elderly care, over time, from the perspective of RNs.

Method:

We interviewed thirteen RNs working in nursing homes, six of them in 2000 and the remaining seven in 2012, and analysed the resulting data using Interpretive Description.

Results:

The results show similarities and differences over time in the RNs’ reasoning about the meaning of their work with older persons, from a focus on obstacles to a view of opportunities.

Conclusion:

An RN’s intention to continue working in elderly care might be based on their beliefs; their view of older people, and their experiences of being able to influence the care. Managing this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing turnover in such nurses. Our results could stimulate reflection on daily care and beliefs about caring for older persons.

Carers’ ambivalence in conflict situations with older persons

The aim of this study was to illuminate the meaning of professional carers’ experiences in caring situations when a conflict of interest arises with the older person receiving care. The findings reveal the complexity of the carers’ ambivalence when facing a conflict of interest, weighing up between the older persons’ right to self-determination and external demands. The carers are alone in their ambivalence, and the conclusion is that they need help and support to be more present in the encounter. The implication for this study is to focus on care as a person-centered practice and to focus on people as interdependent on support carers to maintain older people’s right to self-determination in the relationship.

Advanced nursing assistant education program

BACKGROUND

Nursing assistants provide 90% of the care to the elderly residents of nursing homes, but are the least educated direct-care employees. Supervisory workers believe that nursing assistants require additional training to meet the increasingly complex needs of nursing home residents.

METHODS

A day-long training program for experienced nursing assistants was provided to supplement their basic education. Using a pre- and posttest design, the effectiveness of the program for knowledge acquisition and application was tested. Future education needs were identified through a gap analysis.

RESULTS

There was a significant improvement in knowledge for nursing assistants attending the program. The attendees expressed interest in receiving additional education on dementia and infection control. All attendees identified a problem unique to their facility and were able to plan a detailed intervention and develop outcome measures for that plan.

CONCLUSIONS

Nursing assistants enrolled in this advanced training program expressed a desire for additional education to help them advance their caregiving skills. Advanced education is one method to increase job satisfaction among nursing assistants that can improve the quality of care for nursing home residents.

Health against the odds: experiences of employees in elder care from a gender perspective

Women-dominated elder care in Sweden is a low-paid, low-status job with a high prevalence of sick leave. Our aim was to analyze health experiences of employees in elder care from a gender perspective. All caregiving staff at two establishments providing care to the elderly were invited to participate in the study. A moderator led seven focus group discussions. Qualitative content analysis was used to analyze the transcribed focus groups. We identified two central themes in relation to the employees' health. "Working against the odds" describes gendered workplace stressors of a structural character, to a large extent triggered by societal processes outside the organization. "Making work matter" refers to gendered health resources with a relational character, constructed within the organization. Health-promoting programs directed toward women-dominated workplaces need to include a gender perspective, and focus on creating structural, supportive environments to avoid the negative health effects of the stressors.

Effects of network development on attitudes towards work and well-being at work among health care staff in northern Finland

OBJECTIVES

To assess the effects of network development between primary and special health care units on attitudes towards work and well-being at work among health care staff.

STUDY DESIGN

A prospective quasi-experimental design with intervention (n=33) and control (n=23) groups. This 2-year pilot intervention study was implemented in 14 health centres and 4 hospitals in northern Finland.

METHODS

The material was gathered via self-reported questionnaires from the health care staff at baseline and 1 follow-up. The intervention was composed of regional networking, self-ruling teamwork, staff education and guidance for the multiprofessional teams consisting of participants from primary and special health care units. The objective of these teams was to construct and disseminate regional models of patient education for the service process of 6 patient groups: cardiovascular, COPD, total joint replacement, cerebral infarction, cancer and chronic ulcer patients.

RESULTS

The network development intervention had positive effects on attitudes towards work concerning organizational commitment, occupational commitment and growth satisfaction. The positive effects were also found in well-being at work, measured by absorption. The results are encouraging, although the study failed to demonstrate statistically significant improvements in other attitude and well-being outcomes that were measured.

CONCLUSIONS

Network development intervention particularly improved positive attitudes towards work among health care staff. Although randomized controlled trials are needed, regional network development between health centres and hospitals is recommended when the goal is positive attitudes towards work and well-being at work in sparsely populated and rural areas.

Caregivers' attitudes to education and supervision in work with the older people in a nursing home

Community-based care in Sweden has problems recruiting and keeping staff with formal competence and education. Both the caregiver's well-being and the receiver's care improve when the personnel receive support in the form of continuing supervision and education. Yet the caregivers in this study did not participate in a training and supervision programme during working hours. The aim of this study was to describe the attitudes towards education, support and supervision in the care of older people in municipal care in Sweden. The study used a qualitative approach with a descriptive design. Twelve caregivers, nine enrolled nurses and three nurses' aides from four wards in a nursing home were interviewed. The interviews were analysed with qualitative content analysis. The main findings showed that all of the caregivers were positive towards the idea of participating in training and asked for education and supervision but felt that the management did not create conditions that made it possible to participate during working hours. According to the findings there is a need for developing new forms and methods for learning that can be integrated into working life.

Public nursing home staff's experience of participating in an intervention aimed at enhancing their self-esteem

AIM

The aim of the present study was to gain an understanding of how nursing staff experienced participating in a training programme aimed at strengthening their self-esteem and empowering them, to determine whether participation benefited them in any way, and to describe their opinions about possible benefits or disadvantages.

BACKGROUND

Staff working in institutions such as nursing homes have a low status in society. A training programme was introduced to staff in a public nursing home. It focused on helping them understand factors in the work situation that influence them and on empowering them.

METHOD

The study was explorative and qualitative in design.

FINDINGS

The participants in the programme were generally satisfied with it. Their opinions about the benefits they received from the programme can be described using three themes: 'improved communication skills', 'enhanced self-esteem' and 'sees work in a different light'.

CONCLUSIONS

The most important finding of the present study is that it was possible to strengthen and empower staff. Staff members were generally pleased and satisfied with the content/organization of the training programme. They felt the programme had been of value to them by improving their communication skills and increasing their self-esteem.

IMPLICATIONS FOR NURSING MANAGEMENT

The present result could be of value to managers and educators working in the area of nursing home care when planning education and development activities for staff. Learning to communicate better and understand the social structure at the workplace could improve staff members' self-esteem, thereby enhancing the work situation and atmosphere as well as empowering the individuals.

Developing personal relationships in care homes: realising the contributions of staff, residents and family members

Personal relationships are an integral part of living, working and visiting in care homes, but little research has made relationships the main focus of enquiry, and there have been few studies of the perspectives of residents, staff and family members. The study reported here sought to redress this neglect. Using a constructivist approach, the nature and types of relationships between residents, staff and family members were explored in three care homes in England using combined methods including participant observation, interviews and focus groups. The data collection and analysis occurred iteratively over 21 months and three types of relationships were identified: ‘pragmatic relationships’ that primarily focus on the instrumental aspects of care; ‘personal and responsive relationships’ that engage more fully with the particular needs of individual residents; and ‘reciprocal relationships’ that recognise the roles of residents, staff and family members in creating a sense of community within the home. This paper explores the contributions made by staff, residents and family members in the development of these relationships. The findings enhance our understanding of the role of inter-personal relationships in care home settings and of the factors that condition them. The implications for developing improved practice in care homes are also considered.

Factors Affecting Frontline Workers' Satisfaction With Supervision

Objective: This research was guided by a stress and support model to examine the effects of frontline workers' background characteristics, personal stressors, job-related stressors, and workplace support on satisfaction with supervision. Method: Survey data were collected from 644 workers in 49 long-term—care settings that employed them. Regression analysis were used to determine the effects of worker level and then Hierarchical Linear Modeling (HLM) and organizational factors on the outcome. Results: Although all four variable categories made significant contributions to explaining satisfaction with supervision, the most powerful were personal stressors and job-related stressors. Results from HLM analysis showed frontline workers in nursing homes and those employed in for-profit organizations had lower levels of satisfaction with supervision. Discussion: Findings suggest organizational interventions to address workers' financial and health issues and management practices such as better training programs and peer mentoring could enhance workers' satisfaction with supervision.

The role of education and training in achieving change in care homes: a literature review

Abstract

Care homes play a vital role in the provision of support for the frailest members of our society, and given the demographic trends their role will continue for the foreseeable future. However, there remain enduring concerns about the quality of care such homes provide. Training and education for staff are often seen as the key to raising standards and as such are widely promoted. This paper presents a conceptual review and synthesis of the literature on the role of education and training in initiating and supporting change in care homes. A systematic method to the identification of sources was adopted, and a rigorous three-stage approach to analysis applied. The review identifies the barriers and facilitators to change and concludes that education is a necessary but not a sufficient condition for success. Rather it is argued that the role and status of care homes needs to be raised, and that a relationship-centred approach to care adopted, which acknowledges the importance of attending to the needs of all those who live in, work in, or visit care homes.

Subjective socioeconomic status as a predictor of long-term care staff burnout and positive caregiving experiences

BACKGROUND

The potentially negative consequences associated with providing care to older adults are well documented. Recently, there has been an increasing interest in the positive aspects associated with caregiving. Both aspects are believed to represent a continuum of caregiving experiences. Long-term care (LTC) staff members often report high levels of burnout associated with their work. Whereas several job characteristics and objective indicators of socioeconomic status have been identified as potential predictors of LTC staff caregiving experiences, the role of subjective socioeconomic status (i.e. one's view of one's place in society) has not yet been evaluated.

METHODS

A cross-sectional design of 122 LTC staff members. LTC staff completed the Maslach Burnout Inventory and the Positive Aspects of Caregiving questionnaire. They also completed questions about job characteristics (i.e. staff-to-resident ratio, number of hours worked per day, and years of experience working with older adults), objective sociodemographic variables (i.e. level of education, professional affiliation), and subjective socioeconomic indicator (i.e. MacArthur Scale of Subjective Social Status). Hierarchical regression analyses were conducted to identify the unique contribution of job characteristics, objective socioeconomic status, and subjective socioeconomic status to LTC staff caregiving experiences.

RESULTS

Subjective socioeconomic status remained a significant predictor of LTC staff experience even once job characteristics and objective indicators of socioeconomic status were entered into the model. Those who placed themselves higher on the subjective social ladder reported higher levels of positive caregiving experiences and lower levels of burnout.

CONCLUSIONS

Building a sense of community identity and improving one's status within the community might result in lower levels of burnout and better caregiving experiences among LTC staff.

Relatives' struggle for an improved and more just care for older people in community care

AIMS AND OBJECTIVES

The aim of the present study was to describe the relatives' experience concerning older family members living in special housing facilities.

BACKGROUND

During the 21st century, the relatives of older people and their efforts related to the care and nursing of older people have been observed. The interest in these relatives is because of factors such as demographic changes, where the number of older people has increased and the increasing gap between the resources that are available for geriatric care and the care needed for older people.

DESIGN

The present study has a descriptive design and is part of a project including 24 specific residences, called special housing facilities.

METHOD

The study focused on the narratives supplied by the relatives that were analysed using qualitative latent content analysis, an interpretative process where the researcher considers the content of the text.

RESULTS

The relatives' experience of having an older person in a special housing facility that emerged from the study, was expressed in one main theme: The relatives' struggle for an improved and just care for older people and four sub-themes: (i)'To trust in caregivers'; (ii) 'To be confirmed'; (iii) 'To trust in care'; (iv) 'To receive the kind of care that one considers one has the right to receive'.

CONCLUSIONS

The study shows that the relatives need more support and more opportunities, so that they can participate in the care. The study shows the relatives engagement in working for a just society's obligation towards the protection of older peoples rights and the staff's working conditions.

RELEVANCE TO CLINICAL PRACTICE

It is important that caregivers and management working with older people realize that they, together with them and their relatives, are a part of society and that all individuals are influenced by the discourse of that society.

Attitudes of nursing staff working with older people towards nutritional nursing care

AIM

The aim of this study was to examine attitudes of the nursing staff in geriatric care towards factors of importance for nutritional nursing care.

BACKGROUND

Studies show that nutritional risk assessment is seldom performed on older patients as routine and very few patients have a nutritional care plan. Patients in long-term care who are easy to feed are also found to be looked upon more positively than those with high feeding needs.

METHODS

A total of 252 registered nurses and nurse aids working at geriatric rehabilitation and medical care clinics and resident homes participated in the study. Attitudes were examined using the Staff Attitudes to Nutritional Nursing Care Geriatric scale. The scale includes 18 items and was designed as a one to five-point Lickert-type scale. It gives a total score and five subscales representing the dimensions 'Norms', 'Habits', 'Assessment', 'Intervention' and 'Individualization'. A higher score indicates a more positive attitude.

RESULTS

Of all nursing staff, 53% displayed a positive attitude towards factors of importance for nutritional nursing care and the rest displayed a neutral or negative attitude. The 'Intervention' dimension, dealing with nutritional problems and how to manage them, reflected the highest level of positive attitudes, which represents 71% of the nursing staff. The 'Norms' dimension had the lowest relative frequency of positive attitudes, 27%. The registered nurses held significantly more positive attitudes than the nurse aids did.

CONCLUSIONS

Nutritional issues comprise an important and time-consuming responsibility in geriatric care; however, nursing staff do not show an unequivocal positive attitude regarding this responsibility. The consequences this entails for the older patient need to be examined further. Relevance to clinical practice. Nursing staff play an important role in caring for patients who are malnourished or at risk for malnutrition. Positive attitudes might hinder the development of undernourishment or the further worsening of an already undernourished patient's condition.

Despite shattered expectations a willingness to care for elders remains with education and clinical supervision

The aim was to describe nursing home (NH) caregivers' work experiences while receiving education and clinical supervision for 2 years. Working in elder care seems to be losing its attraction especially with organizational changes, cutbacks and changes in work place conditions. Clinical supervision has been reported to increase job satisfaction and creativity. Semi-structured interviews from caregivers working at an NH in Sweden were conducted, at the start and again at 12 and 24 months. At about 12 months the caregivers were informed of planned cutbacks. Content analysis was the method used to analyse the interviews from seven caregivers who participated throughout the entire period. Findings show that the value of a caring milieu was one category generated by the subcategories: experiences related to work activities and changes, and experiences related to relationships. The value of knowledge was the other category that was influenced by the experiences related to the different backgrounds and the experiences related to increased knowledge gained from the support through education and clinical supervision. The categories contained positive as well as negative influences on care. The initial focus on practical duties associated with the opening of the NH shifted towards caregiver activities with the elders they spoke warmly about. After 2 years the caregivers' willingness to care continued despite their disappointment in the worsened working conditions. The main theme that resulted was: Despite shattered expectations a willingness to care for elders remained. Continued education and clinical supervision seems to be one factor behind the retained willingness. These findings demonstrate that support and caregiver involvement in educational programmes are important during times of change and when disappointments arise in the workplace.

Evaluation of an educational "toolbox" for improving nursing staff competence and psychosocial work environment in elderly care: results of a prospective, non-randomized controlled intervention

BACKGROUND

Lack of professional development opportunities among nursing staff is a major concern in elderly care and has been associated with work dissatisfaction and staff turnover. There is a lack of prospective, controlled studies evaluating the effects of educational interventions on nursing competence and work satisfaction.

OBJECTIVES

The aim of this study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of their competence, psychosocial work environment and overall work satisfaction.

DESIGN

The study was a prospective, non-randomized, controlled intervention.

PARTICIPANTS AND SETTINGS

Nursing staff in two municipal elderly care organizations in western Sweden.

METHODS

In an initial questionnaire survey, nursing staff in the intervention municipality described several areas in which they felt a need for competence development. Measurement instruments and educational materials for improving staff knowledge and work practices were then collated by researchers and managers in a "toolbox." Nursing staff ratings of their competence and work were measured pre and post-intervention by questionnaire. Staff ratings in the intervention municipality were compared to staff ratings in the reference municipality, where no toolbox was introduced.

RESULTS

Nursing staff ratings of their competence and psychosocial work environment, including overall work satisfaction, improved significantly over time in the intervention municipality, compared to the reference group. Both competence and work environment ratings were largely unchanged among reference municipality staff. Multivariate analysis revealed a significant interaction effect between municipalities over time for nursing staff ratings of participation, leadership, performance feedback and skills' development. Staff ratings for these four scales improved significantly in the intervention municipality as compared to the reference municipality.

CONCLUSIONS

Compared to a reference municipality, nursing staff ratings of their competence and the psychosocial work environment improved in the municipality where the toolbox was introduced.

Predictors of changes in sick leave in workers with asthma: a follow-up study

OBJECTIVE

The aim of this prospective study was to investigate predictors of 1-year changes in sick leave in workers with asthma.

METHODS

The initial cohort consisted of 111 workers with asthma. One-hundred and one participants completed the follow-up after 1 year. Self-reported sick leave over the past 12 months was reported at baseline and at follow-up. At the start of this study, all participants completed questionnaires on adaptation to functional limitations, psychosocial variables, working conditions, lung function characteristics, disease history characteristics, health complaints and functional limitations, and person characteristics ('potential predictors'). Three multivariate logistic regression models were calculated, with an increase in sick leave, a decrease in sick leave, and stable high sick leave as dependent (outcome) variables, and the potential predictors as independent (explanatory) variables.

RESULTS

An increase in sick leave was predicted by a lower level of education and perceiving more functional limitations in activities of daily life. A decrease in sick leave was predicted by spending all energy at work less often and perceiving fewer health complaints in social activities (adaptation criteria 4 and 5). Stable high sick leave was predicted by less job satisfaction, perceiving more support from the employer and perceiving more health complaints in social activities (adaptation criterion 5). Lung function characteristics, or disease history characteristics were not predictive for changes in sick leave in any of the groups.

CONCLUSION

We conclude that adaptation to functional limitations played a major role in changes in sick leave in workers with asthma. Lung function characteristics hardly played a role.

Job and organizational determinants of nursing home employee commitment, job satisfaction and intent to turnover

The purpose of this study was to examine whether job characteristics, the work environment, participation in quality improvement activities and facility quality improvement environment predicted employee commitment and job satisfaction in nursing homes, and whether those same predictors and commitment and satisfaction predicted turnover intention. A total of 6,584 nursing home employees from 76 nursing homes in a midwestern state participated. A self-administered questionnaire was used to collect the data. The results supported the hypotheses that job and organizational factors predicted commitment and satisfaction while commitment and satisfaction predicted turnover intentions. The implications for retaining nursing home employees are discussed.