Job strain and stress of conscience among nurse assistants working in residential care

Burnout in healthcare workers: The effect of stress of conscience

PURPOSE

The stress of conscience occurs in stressful situations that are often encountered in healthcare, leading to an uncomfortable conscience in healthcare workers. They may not be able to control their emotions and feel burnout. Therefore, the aim of this study is to evaluate the effect of stress of conscience on burnout in healthcare workers.

METHODS

This cross-sectional study was performed with 602 healthcare workers between November 2020 and January 2021 in Turkey. Data were collected using a sociodemographic form, Stress of Conscience Scale, and Maslach Burnout Inventory.

RESULTS

A positive and high-level relationship was found between the stress of conscience and burnout (r = 0.603, p < 0.001). The stress of conscience accounted for 36% of burnout. Also, female healthcare workers have high stress of conscience and burnout scores.

CONCLUSION

This study is important in terms of realising the stress and burnout of healthcare workers and for health managers to recognise the stress types of their workers. The increase in the level of burnout of healthcare workers is associated with their stress of conscience. Using the results of this study, national and international consensus can be obtained to reduce the impact of the stress of conscience on healthcare workers.

Nurses' and Midwives' Stress of Conscience and Its Correlation With Selected Sociodemographic and Work-Related Variables

AIM

To assess the level of stress of conscience experienced by Polish nurses and midwives and its determinants.

DESIGN

Descriptive cross-sectional study.

METHODS

The study was conducted from March 2019 to December 2020 and included convenience sampling of nurses and midwives working in hospitals in south-eastern Poland. An adapted version of the stress of the conscience questionnaire was used.

RESULTS

A total of 476 nurses and midwives completed the survey. The stress of conscience mean value was 67.57. There were no differences in stress of conscience between nurses and midwives. There were five predictors of stress of conscience for nurses: additional job, place of residence, care for patients over 65 years of age, satisfaction with one's salary and having specialised courses, for midwives: social status, work mode and postgraduate studies.

CONCLUSION

With the knowledge of predictors of stress of conscience, educational institutions, policymakers and hospital managers should focus their interventions on the factors that lead to a higher level of stress of conscience. It is essential to provide psychological support, building positive relationships between colleagues and focusing on organisational conditions.

IMPLICT

Further research in this area is therefore encouraged, along with pre- and postgraduate training in coping with challenging situations such as the death of a patient and caring for elderly patients with dementia or multiple diseases. The study identifies predictors of stress of conscience and problems that can influence their appearance. Factors that increase the stress of conscience, such as organisational conditions and caring after patients are over age 65, should receive special attention in clinical education and result in the provision of an increased level of support from supervisors. Policymakers should also direct their future actions towards the ageing population, staff shortages, the resignation from the profession by improving working conditions and reducing the stress of conscience.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Being used for the greater good while fighting on the frontline: care staff's experiences of working with older people during the COVID-19 pandemic in Sweden

BAKGROUND

Worldwide, older people were more severely affected during the COVID-19 pandemic than others. In Sweden, those living in residential care facilities had the highest mortality rate, followed by those receiving home care services. The Swedish and international literature on the working environment for assistant nurses and care aides during the pandemic shows an increase in stress, anxiety, depression and post-traumatic stress syndromes. Care organisations were badly prepared to prevent the virus from spreading and to protect the staff from stress. In order to be better prepared for possible future pandemics, the health and well-being of the staff, the care of older people and the experiences of the staff both during and after a pandemic are important aspects to take into account. Therefore, this study aims to describe the experiences of assistant nurses and care aides working in the care of older people during the COVID-19 pandemic in Sweden, their working conditions and the impact all this had on their lives.

METHODOLOGY

The study has a qualitative, descriptive design. The data was collected in four focus group interviews with 21 participants and analysed using qualitative content analysis.

RESULTS

The results revealed the theme, Being used for the greater good while fighting on the frontline, which was then divided into three categories: portrayed as a risk for older people, not being valued and being burnt out. The worsening working conditions that the pandemic contributed to resulted in a high degree of stress and risk of burnout, with staff members both wanting to and actually leaving their employment. After the pandemic they felt forgotten again and left to cope in an even worse situation than before.

CONCLUSIONS

The pandemic had a major effect on assistant nurses and care aides in terms of their working environment and their private lives. To be better prepared for future pandemics or disasters, organisations with responsibility for the care of older people will need to ensure that their staff have the necessary competencies and that there is adequate staffing in place. This also means that adequate government funding and multiple interventions will be needed.

Organisational and leadership skills towards healthy workplaces: an interview study with registered nurses in Sweden

BACKGROUND

According to shortage of registered nurses, organisational and leadership aspects grounded in person-centrered approach, are highlighted to ensure high quality of care. Therefore, it is interesting to develop knowledge regarding registered nurses working environment.

AIM

The aim of the study was to investigate registered nurses' reason to end their employment at a university hospital setting (internal medicine, emergency department).

METHOD

Qualitative content analysis with an inductive methodological approach was used to analyse registered nurses' experiences regarding their former employment. Inclusion criteria; all nurses (n = 55) who ended employment during one year (first of July 2020-30th of June 2021) were invited, and 38 semi-structured interviews were conducted.

RESULTS

Three categories were identified: Limited organisational support, Lack of visible leadership, and Limited healthy working environment, followed by six subcategories: Longing for organisational support, Being a tile in a box, Need for professional relationship, Limitation of supportive leadership, Imbalance of work versus personal life, and Ethical stress.

CONCLUSION

To improve registered nurses working environment and commitment to work, balance between time at work and personal life is significant. Therefore, organisational support and leadership skills grounded in a person-centred approach are crucial to develop a healthy working environment. A person-centred leadership could improve collaboration and shared decision-making in partnership with those involved, managers, nurses, and team members.

Perceptions and stress of conscience in relation to burnout among nursing staff in older people care settings: a cross sectional study

BACKGROUND

Considering cultural influences, it is important to study the perceptions and stress of conscience in different contexts. This study aimed to investigate the association between perceptions of conscience, stress of conscience, and burnout among nursing staff working in older people care settings in Tehran.

METHODS

This was a descriptive, cross-sectional study. A total of 161 participants completed the Perceptions of Conscience Questionnaire, Stress of Conscience Questionnaire, and Oldenburg Burnout Inventory, 2019. All nursing staff working at the 20 contacted nursing homes agreed to participate in the study. The descriptive and inferential analysis was conducted through SPSS, using T-tests and one-way between-groups analysis of variance, Chi-square and t-tests, Cohen's d (d), Eta-squared (η2), and Phi coefficient (φ), Partial least squares regression (PLSR), jackknife approximate t-tests of the regression coefficients, and jackknife 95% confidence intervals of the regression coefficients.

RESULTS

The nursing staff perceived their conscience mainly as an authority, asset, and warning signal. Impact of workload on family life was the most common source of stress for the nursing staff. Dealing with incompatible demands, the impact of workload on family life, witnessing insulated patients, inability to meet one's standards in providing care, and perception of conscience as a burden were strongly associated with the burnout.

CONCLUSIONS

Perceiving conscience as a warning signal or authority may serve as a buffer against burnout among nursing staff. This study highlights the need for further exploration of perceptions of conscience in different cultural and social backgrounds.

Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study

BACKGROUND

Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use.

OBJECTIVE

The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems.

METHODS

The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods.

RESULTS

The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements "workload" and "distress" were important determinants of home care staff health, provision, and quality of care.

CONCLUSIONS

The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.

Relationship Between Dementia Knowledge and Occupational Strain Among Staff of Residential Facilities for Older Adults: A Cross-sectional Survey

Working with people living with dementia in residential facilities for older adults can be challenging, and this is exacerbated when staff have a limited understanding of dementia. However, the relationship between knowledge of dementia and strain in caring for people with dementia among residential facility staff is unclear. This cross-sectional study investigated the relationship between dementia knowledge and strain in caring for people with dementia. A questionnaire containing the Dementia Knowledge Assessment and Strain in Dementia Care Scales was administered in 2017 and 2019 to 141 staff in three southern Australian residential facilities for older adults. Bivariate and hierarchical regression analysis examined inter-scale relationships and the power of dementia strain to explain knowledge variance. It was found that staff had substantial gaps in dementia knowledge (mean score 32/50) and low strain in dementia care (mean score 4/16). A positive relationship was found between higher dementia knowledge and greater strain in dementia care (rs = 0.319, p < .001), particularly with feeling that residents are not receiving appropriate care from colleagues (Factor 1 Frustrated Empathy; rs = 0.392, p < .001). Frustrated Empathy explained a significant amount of variance in dementia knowledge beyond demographic variables. The findings suggest that more comprehensive dementia knowledge is associated with higher strain in care of people with dementia, particularly in the context of perceived lapses in the quality of care provided by colleagues. Arguably, organisational-wide dementia education to address identified gaps should be supported by facilitating staff enaction of their knowledge to improve care.

Longitudinal changes in nursing home leadership, direct care staff job strain and social support in Swedish nursing homes-findings from the U-AGE SWENIS study

BACKGROUND

Promoting healthy work environment as a manager in nursing homes is important to safeguard staff health and well-being as well as care quality when facing increasing demands. The impact of leadership on staff work environment needs further exploration.

OBJECTIVES

To describe longitudinal changes in nursing home leadership, direct care staff characteristics, job strain and social support.

METHODS

This study has a repeated cross-sectional design, a five-year follow-up study. Nursing home staff in 181 corresponding units (n = 1253 in 2014 and n = 1176 in 2019) completed surveys about leadership, staff job strain and social support in a five-year follow-up study. Descriptive and regression analyses were conducted.

RESULTS

A higher degree of leadership defined by coaching and providing direct feedback to care staff, handling conflicts in a constructive way and having control of the clinical work, was significantly associated with a lower degree of job strain and a higher degree of social support among staff, with stronger associations at follow-up. The proportion of enrolled nurses increased significantly at follow-up.

CONCLUSIONS

Leadership is increasingly important for staff work environment, especially in times of increased workload and decreasing collegiality and deteriorating work atmosphere at work.

IMPLICATIONS FOR PRACTICE

Stakeholder and policy makers in nursing home care may reflect on how managers' leadership is prioritised in these environments because such leadership is associated with staff job strain and social support. Managers striving to improve the work situation of staff may consider their own role and allow flexibility in how and when the work can be performed.

Individual and organisational factors in the psychosocial work environment are associated with home care staffs' job strain: a Swedish cross-sectional study

BACKGROUND

Home care staff (HCS) provide essential service to enable older adults to age in place. However, unreasonable demands in the work environment to deliver a safe, effective service with high quality has a negative impact on the individual employee's well-being and the care provided to the older adults. The psychosocial work environment is associated with employees´ well-being, although, knowledge regarding which individual and organisational factors that contribute to job strain for HCS is limited. These factors need to be identified to develop targeted interventions and create sustainable work situations for HCS. This study aimed to explore how HCS´s perceived job strain is associated with, and to what extent can be explained by, individual and organisational factors of the psychosocial work environment and psychosomatic health.

METHOD

An explorative cross-sectional questionnaire survey design was used in a large Swedish county. Five home care agencies with a total of 481 HCS were asked to respond to a questionnaire regarding their perceived level of job strain (Strain in Dementia Care Scale), psychosocial work environment (QPS_Nordic³⁴⁺), and psychosomatic health (Satisfaction with Work Questionnaire). Multiple linear regression (MLR) analyses were conducted to explore the association between job strain and individual and organisational factors.

RESULTS

In total, 226 (46%) HCS responded to the questionnaire. Both individual and organisational factors were significant predictors of job strain and explained a variance ranging between 39 to 51% (p = 0.001). The organisational factor job demand and the individual factor feeling worried and restless was most frequently represented in these MRL models. A higher job strain was also associated with adverse outcomes regarding leadership, organisational culture and climate, and control at work.

CONCLUSION

This study indicates that there is an intertwined complexity of individual and organisational factors that are associated with the HCS´s perception of job strain. Implementation of new multidimensional work strategies, such as a reablement approach, could support the development of efficient strategies for HCS and reduce the level of job strain. Policy changes for the provision of home care are also needed to support the development of a sustainable and healthy psychosocial work environment.

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.

Stress of conscience and burnout among nurses in Turkey

PURPOSE

To investigate the validity and reliability of the Turkish version of the Stress of Conscience Questionnaire (SCQ) and to determine its relationship to burnout among Turkish nurses.

DESIGN AND METHODS

The sample of this study with a cross-sectional design comprised 375 nurses. The data were collected using the Maslach Burnout Inventory (MBI) and SCQ.

FINDINGS

The mean score of the nurses obtained from the overall SCQ was 85.36 ± 39.3 (min: 0; max: 225). The highest scored item by the nurses was related to "lack of energy to devote themselves to their families." There was a significant positive correlation between the Emotional Exhaustion-MBI scores and SCQ scores (r = 0.414, p < 0.001).

PRACTICE IMPLICATIONS

The Turkish version of SCQ is a valid and reliable tool among Turkish nurses and is associated with emotional exhaustion.

Bring me my alcohol!-On the continuum of pleasure and pain

Alcohol use has been recognized as a challenge in eldercare and social care, and some anticipate that problems related to alcohol use will increase in the future as the current adult generation has high alcohol consumption rates. Accordingly, it is suggested that care workers are at risk of becoming passive bystanders to the destructive lifestyles of vulnerable older adults and even facilitating these lifestyles. In the present paper, we suggest that alcohol exacerbates and underscores inherent difficulties in eldercare, such as finding an appropriate balance between the personal freedom of the older adult and the responsibility of the care worker to provide care. The specific focus in the paper regard the communication and interaction involving values between people in eldercare in cases of problematic alcohol-related situations to uncover the difficulties. We found it noteworthy that the objectives and perspectives of older adults, care workers, managers and relatives have implications regarding their interactions and communications because their varying experiences involve values that are not necessarily aligned. Sometimes, care workers have no choice but to act against what, in the public sphere and to the other care workers, is ruled out by virtue of their professional ethics. It is suggested that care workers describe and judge situations where alcohol is present paradoxically by virtue of their professional ethics, yet regulate their care to preserve the dignity of older adults, even when they find the situation to be an apparent dilemma.

The extent and nature of stress of conscience among healthcare workers: A scoping review

BACKGROUND

Healthcare workers experience morally stressful situations during delivery of care which may trouble their conscience. Literature emerging in the context of global pandemics suggest increased frequency of morally stressful situations in healthcare and a link with negative outcomes such as attrition and burnout. Little is known about the emerging concept of stress of conscience which could provide a meaningful way to highlight and address these morally stressful situations in healthcare.

AIM

The aim of this scoping review was to provide an overview of the literature on, (i) the extent, (ii) the factors associated, and (iii) the interventions to prevent or mitigate stress of conscience among healthcare workers.

DESIGN

The study was guided by the framework provided by Arksey and O'Malley in 2005 and the PRISMA Guidelines. Relevant healthcare databases were searched in November 2020 to identify relevant studies.

RESULTS

The search identified 24 studies for inclusion in the analysis, 19 of these were from Nordic countries, particularly Sweden. Across those studies, stress of conscience was prevalent among healthcare workers and the levels varied with demographic factors, individual personalities, perceptions of belonging and the workplace culture and environment. Stress of conscience was associated with negative outcomes such as burnout, moral burden, workplace stress, and low quality of care. Although there were few quality interventions studies, facilitating healthcare workers to provide person-centred care appears to be a promising intervention.

CONCLUSIONS

The concept of stress of conscience provides a contemporary framework to assess, highlight and discuss the degree of the negative impact of perceived violations of professional and personal values in healthcare. However, the limited studies suggest that exploring stress of conscience, including trials of potential interventions, particularly beyond Nordic countries is essential to fill the gaps in the literature.

Ergonomic assessment of work-related musculoskeletal disorder and its determinants among commercial mini bus drivers and driver assistants (mini bus conductors) in Nigeria

Introduction

Work-related musculoskeletal disorder (WMSD) is a leading causes of occupational injury and disability among drivers and workers in the transport industry. This study evaluated the ergonomically assessed WMSD and its determinants among Nigerian commercial mini bus drivers (BD) and mini bus conductors (BC)

Method

A total of 379 participants (BD = 200, BC = 179) were purposively sampled for this exploratory cross-sectional study. Participants’ WMSD and work related variables were respectively assessed using the standardized Nordic questionnaire and a content-validated, Driving Work Station Assessment (DWSA) form. Data were analyzed descriptively and inferentially using chi-square and logistic regression. The level of significance was set at α = 0.05.

Results

The participants were aged between 20 and 66 years, with a mean age of 33.26±10.76years (BD = 38.42±10.22years, BC = 27.50±8.13years); most of whom consumed alcohol (84.4%) and experienced severe job stress (73.4%). There was a high prevalence (95.8%; BD = 94.5%, BC = 97.8%) of WMSDs, the lower back (66.8%) and upper back (54.1%) had the highest regional prevalence of WMSD. The BC (BC vs BD) had significantly (p<0.05) higher prevalence of Neck (47.7% vs 21.5%) and upper back (80.4% vs 30.5%) WMSDs. Conversely, the BD (BD vs BC) had significantly (p<0.05) higher prevalence of low-back (85.0% vs 46.4%), knee (25.0% vs 9.5%), elbow (11.5% vs 3.9%), and wrist (10.5% vs 3.4%) WMSD. There was a significant association between WMSD and each of work duration (X² = 11.634, p = 0.009), work frequency (X² = 8.394, p = 0.039), job dissatisfaction (X2 = 10.620, p = 0.001) and job stress (X² = 16.879, p = 0.001). Working beyond 4days/week (OR = 10.019, p = 0.001), job dissatisfaction (OR = 1.990, p = 0.031), constrained working postures (OR = 5.324, p = 0.003) and fatigue (OR = 4.719, p = 0.002) were the predictors of WMSD.

Conclusion

Job stress, work duration and work frequency, posture and fatigue are important determinants of WMSDs among mini bus drivers and their assistants in Nigeria. Ergonomics training intervention for this population is recommended.

The influence of nursing home managers' leadership on person-centred care and stress of conscience: A cross-sectional study

Background

Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience.

Methods

This study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations.

Results

Leadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders.

Conclusion

Nursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.

The significance of nursing home managers' leadership-longitudinal changes, characteristics and qualifications for perceived leadership, person-centredness and climate

AIMS AND OBJECTIVES

The aim was to explore changes in nursing home managers' leadership, person-centred care and psychosocial climate comparing matched units in a five-year follow-up and to explore the significance of managers' educational qualifications and the ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate in the follow-up data.

BACKGROUND

Leadership has been described as crucial for person-centred care and psychosocial climate even though longitudinal data are lacking. The significance of managerial leadership, its characteristics, managerial qualifications and ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate also needs further exploration.

DESIGN

Repeated cross-sectional study.

METHODS

This study used valid and reliable measures of leadership, person-centred care, psychosocial climate and demographic variables collected from managers and staff n = 3605 in 2014 and n = 2985 in 2019. Descriptive and regression analyses were used. The STROBE checklist was used in reporting this study.

RESULTS

Leadership was still positively significantly associated to person-centred care in a five-year follow-up, but no changes in strength were seen. Leadership was still positively significantly associated with psychosocial climate, with stronger associations at follow-up. Six leadership characteristics increased over time. It was also shown that a targeted education for nursing home managers was positively associated with person-centred care.

CONCLUSIONS

Leadership is still pivotal for person-centred care and psychosocial climate. Knowledge of nursing home managers' leadership, characteristics and educational qualifications of significance for person-centred delivery provides important insights when striving to improve such services.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used for management and clinical practice development initiatives because it was shown that nursing home managers' leadership is vital to person-centred care practices and improves the climate for both staff and residents in these environments.

Maximizing Home Health Aide Retention: The Impact of Control and Support on the Job

BACKGROUND AND OBJECTIVES

This study examined relationships between the level of control and support and home health aides (HHAs) job satisfaction and intent to leave the job.

RESEARCH DESIGN AND METHODS

Data derive from a survey of 512 HHAs in Massachusetts. Logistic regression using generalized estimating equations was employed for the analysis. Dependent variables included satisfaction and intent to leave the job as a home care aide generally and satisfaction and intent to leave the job at the aide's current agency.

RESULTS

The findings showed that greater control and support on the job were important predictors of positive work outcomes, controlling for job demands and other covariates. The odds of HHAs being satisfied with their job as a home care aide increased with the degree of control, whereas the odds of HHAs being satisfied with their job at their current agency increased with the extent of support. Control was negatively associated with HHAs' intent to leave the job as an aide; no relationship was found between control or support and HHAs' intent to leave their current agency.

DISCUSSION AND IMPLICATIONS

The results from this study illustrate the importance for HHAs of having control and autonomy in their work, as well as the benefit of support from supervisors and the home care agency, on satisfaction and intent to leave. Expanding HHA's ability to maintain control over their day-to-day work, as well as enhancing the supports available to them, is likely to benefit home care workers, clients, and agencies through increased retention.

Assessments of stress of conscience, burnout and social support amongst care providers in home care and residential care for older people

BACKGROUND

Studies points to that levels of stress of conscience and burnout among staff in healthcare contexts may seriously affect their health.

AIM

To compare assessments and associations of stress of conscience, perceptions of conscience, social support and burnout amongst care providers working in home care respectively residential care for older people.

METHODS

This cross-sectional descriptive comparative study was performed among all care providers working in home care (n = 227) and residential care of older people (n = 354) in a municipality in northern Sweden. Data was collected using four different questionnaires. Analysis were performed using partial least square regression, descriptive statistics, statistical tests and effect size measures.

RESULTS

Care providers in residential care of older people assessed higher levels of stress of conscience compared to those working in home care. Exhaustion was an important predictor for belonging to the group of care providers working in residential care of older people. The most important predictor for belonging to the group of care providers working in home care were social support from one's immediate superior and co-workers. Women assessed significantly higher levels of stress of conscience and exhaustion compared to men.

CONCLUSION

Further research seems needed to investigate what the high levels of stress of conscience is caused by. A combined intervention consisting of work-directed measures against burnout and measures aiming at reducing stress of conscience is suggested.

Framework for patient, family-centred care within an Australian Community Hospital: development and description

OBJECTIVE

To describe the development of a patient and family-centred care (PFCC) conceptual framework within a small community Australian Hospital.

METHODS

A scoping review of scientific and grey literature and community hospital stakeholder discussions were used to identify and design a conceptual framework for PFCC across five core pillars of leadership, engagement, service delivery, learning and environment.

RESULTS

107 publications were identified and 76 were included for data extraction. A draft framework was constructed and modified following consultation with hospital stakeholders across a small Australian Community Hospital. The 'Caring Together' framework outlines three core layers: (1) the focus of our care is the experiences of our consumers and staff; (2) concepts of leadership, environment, service delivery, engagement and learning; and (3) the overarching fundamental values of being heard, respected, valued and supported by staff and consumers at all levels in an organisation.

CONCLUSIONS

The conceptual Caring Together framework structures key PFCC concepts across organisational priority areas within an Australian healthcare setting and can be used to guide implementation of PFCC at other small hospital facilities. Changes to national and state healthcare funding may help facilitate improved hospital facility implementation of PFCC, and ultimately improve consumer healthcare satisfaction and clinical outcomes.

Stress of Conscience Questionnaire (SCQ): exploring dimensionality and psychometric properties at a tertiary hospital in Australia

BACKGROUND

This study explored the psychometric properties and dimensionality of the Stress of Conscience Questionnaire (SCQ) in a sample of health professionals from a tertiary-level Australian hospital. The SCQ, a measure of stress of conscience, is a recently developed nine-item instrument for assessing frequently encountered stressful situations in health care, and the degree to which they trouble the conscience of health professionals. This is relevant because stress of conscience has been associated with negative experiences such as job strain and/or burnout. The validity of SCQ has not been explored beyond Scandinavian contexts.

METHODS

A cross-sectional study of 253 health professionals was undertaken in 2015. The analysis involved estimates of reliability, variability and dimensionality. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to explore dimensionality and theoretical model fit respectively.

RESULTS

Cronbach's alpha of 0.84 showed internal consistency reliability. All individual items of the SCQ (N = 9) met the cut-off criteria for item-total correlations (> 0.3) indicating acceptable homogeneity. Adequate variability was confirmed for most of the items, with some items indicating floor or ceiling effects. EFA retained a single latent factor with adequate factor loadings for a unidimensional structure. When the two-factor model was compared to the one-factor model, the latter achieved better goodness of fit supporting a one-factor model for the SCQ.

CONCLUSION

The SCQ, as a unidimensional measure of stress of conscience, achieved adequate reliability and variability in this study. Due to unidimensionality of the tool, summation of a total score can be a meaningful way forward to summarise and communicate results from future studies, enabling international comparisons. However, further exploration of the questionnaire in other cultures and clinical settings is recommended to explore the stability of the latent one-factor structure.

Facilitators and Barriers Surrounding the Role of Administration in Employee Job Satisfaction in Long-Term Care Facilities: A Systematic Review

Previous literature has shown how associate engagement has positively impacted on productivity, job satisfaction, safety, retention, consumer sentiment, and financial performance in hospitals and healthcare systems. However, a lack of research showing the relationship between associate engagement and job satisfaction within the long-term care environment has existed. Our objective was to investigate characteristics within the long-term care environment that promote and detract from associate job satisfaction and extrapolate the best practices in maintaining job satisfaction and engagement. This systematic review queried CINAHL, PubMed (MEDLINE), and Academic Search Ultimate databases for peer-reviewed publications for facilitators and barriers commensurate with employee job satisfaction in long-term care facilities using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Kruse Protocols. The authors identified 11 facilitators for job satisfaction and 18 barriers to job satisfaction in the 60 selected articles. The top four facilitators were Supportive Leadership, Capable and Motivated Employees, Positive Organizational Values, and Social Support Mechanisms. The top four barriers were condescending management style, high job demands, lack of self-care, and lack of training with medically complex patients. The systematic review revealed the importance of maintaining satisfied employees in the long-term care workplace through am emphasis leadership and on the facilitators identified to best serve their associates and improve care for residents.

Effects of a person-centred and thriving-promoting intervention on nursing home staff job satisfaction: A multi-centre, non-equivalent controlled before-after study

Aim

To evaluate the effects of a person‐centred and thriving‐promoting intervention in nursing homes on staff job satisfaction, stress of conscience and the person‐centredness of care and of the environment.

Design

A multi‐centre, non‐equivalent control group, before–after trial design.

Methods

Staff (N = 341) from six nursing homes in Australia, Norway and Sweden were assigned to the intervention or the control group and both groups were evaluated before the intervention, immediately after and by 6 months follow‐up. Staff completed a questionnaire about job satisfaction (primary endpoint), stress of conscience and the person‐centredness of care and of the environment (secondary endpoints). Linear regression models were used to identify the mean scores and to analyse group differences to test the effects of the intervention.

Results

The intervention had no statistically significant effects on staff job satisfaction, level of stress of conscience or the perceived person‐centredness of care and of the environment.

Effects of a practical training programme on burnout among professional caregivers in a care home for older adults with dementia: a pilot study

AIM

As the number of persons with dementia has increased so has the need for both specialized care and long-term care centres. Professional caregivers working in these centres encounter specific problems, including stress, burnout, and feelings of dissatisfaction, each which can affect the quality of care. Due to the nature of their work, they are more likely to experience stress, which may lead to burnout syndrome. Therefore, the aim of this work was to assess the results of a practical training programme with regard to burnout among direct care professionals in a nursing home for people with dementia.

METHODS

A practical training programme was conducted for caregivers at the Sagrado Corazón de Jesús Nursing Home in Cuenca, Spain. The programme used a dynamic, interactive methodology to provide training related to concepts and strategies for dementia care. Weekly 2-h sessions were held over 9 months, from April 2016 to January 2017, with the post-test administered in February. Pretest and post-test measures were taken for a sample of 36 caregivers. An anova was used to analyze the differences in means before and after training. An ancova was also performed to determine the effects of the intervention.

RESULTS

The results revealed a significant difference between pre- and post-intervention emotional exhaustion and depersonalization scores. Personal accomplishment scores improved, but the changes were not significant.

CONCLUSION

A practical training programme for direct care professionals working with dementia patients can decrease burnout levels.

Dementia Care Education Targeting Job Strain and Organizational Climate Among Dementia Care Specialists in Swedish Home Care Services

Introduction

An increasing number of older persons live at home with various limitations, such as dementia, requiring well-educated and trained home care staff to meet their complex care needs. Dementia care specialists working in home care service have reported high levels of job strain in comparison with home care staff in general.

Aim

This pilot study aims to evaluate the effects of a dementia care education model targeting self-reported job strain and organizational climate, among dementia care specialists in home care service.

Methods

A quasi-experimental, one-group pretest–posttest design was applied, with 12 months’ follow-up. Participants were dementia care specialists who worked in home care service (n=34 baseline; n=30 follow-up). The data were collected using the Strain in Dementia Care Scale and Creative Climate Questionnaires, administered pre- and post-intervention. The intervention applied an educational model based on previous research in dementia care and a person-centered approach.

Results

The educational model was implemented in the context of home care services. Of 34 participants at baseline, only 21 responded to the questionnaires, due to a drop off of 13 participants and recruitment of 9 new participants (follow-up=30). A significantly reduced perceived job strain among the participants was detected, indicating perceiving less difficulty in “Balancing competing needs” when caring for the older persons. No significant difference was found in the self-reported creative organizational climate between the two occasions.

Conclusion

The educational model could be integrated into dementia home care and it seemed to reduce job strain among dementia care specialists. Future studies are needed to evaluate the effects of the intervention using a stronger study design and a larger sample.

Support workers' experiences of work stress in long-term care settings: a qualitative study

Background: Support-workers’ performance and well-being are challenged by increasingly high workloads and poor working conditions, leading to high levels of occupational stress.

Aims: To explore the experiences of work stress for support-workers in New Zealand residential facilities.

Design: An Interpretive Descriptive study.

Methods: Data from ten (n = 10) support-workers were collected between December 2013 and June 2014, using semi-structured in-depth face-to-face interviews. Thematic analysis was used to identify key themes that captured participant reports of their experiences.

Results: Work stress was conceptualized by participants as being an everyday experience of having too much to deal with and feeling under constant pressure. It appeared to be a complex and fluid experience representing an inherent, dynamic tension between reasons to be a caregiver and the burden of caregiving. Participants highlighted a range of influencing factors (including lack of recognition, person and work context, and coping strategies), which may account for that fluidity.

Conclusion: The findings extend current knowledge about support-workers’ work stress by identifying the challenges relating to the lack of recognition of their role and expertize, the unintended consequences of person-centered care and the challenges faced by migrant support-workers.

Job strain: a cross-sectional survey of dementia care specialists and other staff in Swedish home care services

Introduction

An increasing number of older persons worldwide live at home with various functional limitations such as dementia. So, home care staff meet older persons with extensive, complex needs. The staff’s well-being is crucial because it can affect the quality of their work, although literature on job strain among home care staff is limited.

Aim

To describe perceived job strain among home care staff and to examine correlations between job strain, personal factors, and organizational factors.

Methods

The study applied a cross-sectional survey design. Participants were dementia care specialists who work in home care (n=34) and other home care staff who are not specialized in dementia care (n=35). The Strain in Dementia Care Scale (SDCS) and Creative Climate Questionnaire instruments and demographic variables were used. Descriptive and inferential statistics (including regression modeling) were applied. The regional ethical review board approved the study.

Results

Home care staff perceived job strain – particularly because they could not provide what they perceived to be necessary care. Dementia care specialists ranked job strain higher (m=5.71) than other staff members (m=4.71; p=0.04). Job strain (for total score and for all five SDCS factors) correlated with being a dementia care specialist. Correlations also occurred between job strain for SDCS factor 2 (difficulties understanding and interpreting) and not having Swedish as first language and SDCS factor 5 (lack of recognition) and stagnated organizational climate.

Conclusion

The study indicates that home care staff and particularly dementia care specialists perceived high job strain. Future studies are needed to confirm or reject findings from this study.

Job strain in nursing homes-Exploring the impact of leadership

AIMS AND OBJECTIVES

To explore the association between nursing home managers' leadership, job strain and social support as perceived by direct care staff in nursing homes.

BACKGROUND

It is well known that aged care staff experience high levels of job strain, and that aged care staff experiencing job strain are exposed to increased risk for adverse health effects. Leadership styles have been associated with job strain in the literature; however, the impact of perceived leadership on staff job strain and social support has not been clarified within nursing home contexts.

DESIGN

This study had a cross-sectional design.

METHODS

Participating staff (n = 3,605) completed surveys which included questions about staff characteristics, valid and reliable measures of nursing home managers' leadership, perceived job strain and social support. Statistical analyses of correlations and multiple regression analysis with interaction terms were conducted.

RESULTS

Nursing home managers' leadership were significantly associated with lower level of job strain and higher level of social support among direct care staff. A multiple regression analysis including an interaction term indicated individual and joint effects of nursing home managers' leadership and social support on job strain.

CONCLUSIONS

Nursing home managers' leadership and social support were both individually and in combination associated with staff perception of lesser job strain. Thus, nursing home managers' leadership are beneficial for the working situation and strain of staff.

RELEVANCE TO CLINICAL PRACTICE

Promoting a supporting work environment through leadership is an important implication for nursing home managers as it can influence staff perception of job strain and social support within the unit. By providing leadership, offering support and strategies towards a healthy work environment, nursing home managers can buffer adverse health effects among staff.

Inpatient dependency in activities of daily living predicts informal caregiver strain: A cross-sectional study

AIMS AND OBJECTIVES

To investigate what factors influence caregiver strain in informal caregivers just before inpatients are discharged.

BACKGROUND

Previous research has investigated the risk factors related to the burden on caregivers in different clinical contexts. However, the findings from studies analysing these factors just before inpatients are discharged are uncertain.

DESIGN

A cross-sectional study design.

METHODS

The study involved 100 inpatients and 100 informal caregivers from seven different hospital units. Sociodemographic, clinical, functional and cognitive factors of inpatients-caregivers, and caregiver strains were recorded. Descriptive, bivariate correlation and multiple regression analyses were performed.

RESULTS

Caregivers of inpatients at risk of ulcers had significantly higher scores of strain. Dependency in activities of daily living scores and cognitive status scores were statistically inversely proportional to caregiver strain. Almost 27% of total variance of caregiver strain was due to dependency in activities of daily living.

CONCLUSIONS

Caregiver strain was mainly associated with those situations in which the hospitalised patients presented the risk of ulcers, dependency and cognitive disorders, with dependency in activities of daily living being the factor that most influenced informal caregiver strain.

RELEVANCE TO CLINICAL PRACTICE

Dependency in activities of daily living, among other risk factors, should be evaluated at an early stage, monitored and controlled by hospital nursing staff. These strategies could protect and promote the well-being and quality of life of informal caregivers during patient hospitalisation and after discharge.

Experiences of a PAR Intervention in Care for Older People

Participatory action research (PAR) is an approach for dealing with problematic areas in practice. Follow-up studies in which participants describe their participation in PAR in detail are rare. This follow-up study aimed to describe care providers' (CPs) experiences of having participated in a PAR intervention designed to assist them to constructively deal with troubled conscience. Twenty-nine CPs who participated in a PAR intervention were interviewed 2 to 4 months post-intervention. Content analysis was used to analyze the data. The analysis revealed three main categories: the importance of having a communal and collaborative meeting place, perceived changes in daily life, and "It has been good, but it has not solved all of our problems." Using PAR to deal with troubled conscience might be an important organizational investment for the future that can help prevent ill health among CPs and maintain or improve the quality of care.

Assessments of Stress of Conscience, Perceptions of Conscience, Burnout, and Social Support Before and After Implementation of a Participatory Action-Research-Based Intervention

Interventions aiming to constructively address stress of conscience are rare. The aim of the study was to compare assessments of stress of conscience, perceptions of conscience, burnout, and social support among health care personnel (HCP) working in municipal residential care of older adults, before and after participation in a participatory action research (PAR) intervention aiming to learn to constructively deal with troubled conscience. Questionnaire data were collected at baseline and at follow-up (1-year interval; n = 29). Descriptive statistics and nonparametric statistical tests were used to make comparisons between baseline and follow-up. HCP gave significantly higher scores to the question, “Are your work achievements appreciated by your immediate superior?” at follow-up compared with baseline. No significant differences in levels of stress of conscience and burnout at follow-up were found. The results suggested that a PAR intervention aiming to learn HCP to deal with their troubled conscience in difficult situations could be partially successful.

Going public: reflections on developing the DöBra research program for health-promoting palliative care in Sweden

Introduction: Public health approaches to end-of-life (EoL) research and care are relatively rare in Sweden, and health-promoting palliative care (HPPC) remains a foreign concept for most. We recently consolidated our HPPC endeavors into a cohesive research program, DöBra, to promote constructive change and awareness to support better quality of life and death among the general population, in specific sub-groups, and in interventions directed to professional groups caring for dying individuals, their friends and families. Objectives: In this article, we aim to share ideas, experiences, and reflections from the early stages of this research program, particularly in relation to how we try to work with new 'publics', to contribute to the development of HPPC as a new research field. Methods and Results: We discuss some considerations which arise in the Swedish context, and present the underlying ideas and approaches used in the research program, with examples of their application. HPPC, based on ideas from new public health, is essential as an umbrella for the DöBra program. Action research, experience-based co-design, and knowledge exchange, all aim to bring together a variety of stakeholders to exchange ideas and expertise, and co-create experience-based evidence through knowledge generation, dissemination, and sharing. Discussion: In reflecting on what we have learned about publics and partnerships in EoL research to date, we question distinctions made between professionals and publics, concluding that including publics in public health research, means also including ourselves and making public many of the reflections, the mistakes, and the experiences we all have, to foster collective learning.

The Development of the strain in dementia care scale (SDCS)

BACKGROUND

Though many staff gain satisfaction from working with people with dementia in residential facilities, they also experience significant stress. This is a serious issue because this in turn can affect the quality of care. There is, however, a lack of instruments to measure staff strain in the dementia-specific residential care environment, and the aim of this study, accordingly, was to develop the "Strain in Dementia Care Scale."

METHODS

The instrument was developed in three steps. In the first step, items were derived from six focus group discussions with 35 nurses in the United Kingdom, Australia, and Sweden concerning their experience of strain. In the second step, a preliminary 64-item scale was distributed to 927 dementia care staff in Australia and Sweden, which, based on exploratory factor analysis, resulted in a 29-item scale. In the final step, the 29-item scale was distributed to a new sample of 346 staff in Sweden, and the results were subjected to confirmatory factor analysis.

RESULTS

The final scale comprised the following 27 items producing a five-factor solution: Frustrated empathy; difficulties understanding and interpreting; balancing competing needs; balancing emotional involvement; and lack of recognition.

CONCLUSIONS

The scale can be used (a) as an outcome measurement in residential care intervention studies; (b) to help residential facilities identify interventions needed to improve staff well-being, and, by extension, those they care for; and

Psychosocial work environment, stress factors and individual characteristics among nursing staff in psychiatric in-patient care

The psychosocial work environment is an important factor in psychiatric in-patient care, and knowing more of its correlates might open up new paths for future workplace interventions. Thus, the aims of the present study were to investigate perceptions of the psychosocial work environment among nursing staff in psychiatric in-patient care and how individual characteristics--Mastery, Moral Sensitivity, Perceived Stress, and Stress of Conscience--are related to different aspects of the psychosocial work environment. A total of 93 nursing staff members filled out five questionnaires: the QPSNordic 34+, Perceived Stress Scale, Stress of Conscience Questionnaire, Moral Sensitivity Questionnaire, and Mastery scale. Multivariate analysis showed that Perceived Stress was important for Organisational Climate perceptions. The Stress of Conscience subscale Internal Demands and Experience in current units were indicators of Role Clarity. The other Stress of Conscience subscale, External Demands and Restrictions, was related to Control at Work. Two types of stress, Perceived Stress and Stress of Conscience, were particularly important for the nursing staff's perception of the psychosocial work environment. Efforts to prevent stress may also contribute to improvements in the psychosocial work environment.