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Baek S, Shin O, Park S, Ko A, Park S, Kang EN. The Relationship between the Working Environment and Quality of Life among Home Health Aides: Focusing on the Mediation Role of Burnout. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-22. [PMID: 39105540 DOI: 10.1080/01634372.2024.2372111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 08/07/2024]
Abstract
As South Korea's population rapidly ages, there is an increasing demand for home aides. However, little is known about how the caregiving environment affects HHAs. Guided by the environment comfort model, we examined the association between care recipients' home environment and HHA's quality of life, focusing on how burnout mediates this relationship. Our data came from a national survey of home health aides in 2020 (N = 786). We conducted an exploratory factor analysis to identify six factors related to the care environment in three dimensions: physical (1. space; 2. indoor/outdoor conditions), functional (3. home appliances; 4. heating/air conditioning), and psychological (5. satisfaction with the home environment; 6. relationships with care recipients and their families). We then used a path analysis to examine the relationship between these factors, burnout, and quality of life. Our findings show that safe indoor/outdoor conditions and positive relationships with care recipients and their families are associated with lower levels of burnout, leading to a higher quality of life (p < .05). This highlights the importance of considering both physical and psychological aspects of the caregiving environment to prevent burnout and improve the quality of life for HHAs, ultimately contributing to high-quality services for care recipients.
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Affiliation(s)
- Sehyun Baek
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
| | - Oejin Shin
- School of Social Work, Illinois State University, Normal, Illinois, USA
| | - Soobin Park
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
| | - Ahra Ko
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, South Korea
| | - Sojung Park
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
| | - Eun-Na Kang
- Korean Institute for Health and Social Affairs (KIHASA), Sejong, South Korea
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Ollé-Espluga L, Vargas-Leguas H, Torrens Mèlich L, Juan Serra M, Arcas MM, Cortès-Franch I. Application of a new municipal management model of Home Care Service in Barcelona: Assessment of workers' labour conditions, health, and well-being. Work 2024:WOR230668. [PMID: 38995754 DOI: 10.3233/wor-230668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND In 2018, Barcelona City Council implemented a pilot phase of an organisational change in the municipal home care service (HCS) system. Inspired in the Buurtzorg model, the new model promotes the creation of self-managing teams operating in a restricted community setting. OBJECTIVE To assess the pilot phase of the new model, focusing on employees' working and employment conditions as well as on their health and well-being outcomes. METHODS Mixed-methods impact evaluation. First, a quantitative evaluation was conducted between October 2018 and October 2020, using a pre-post study design with one pretest and two posttest measurements in an intervention and a comparison group. The intervention group was composed of the members of the work teams implemented in the pilot phase from October 2018 onwards (baseline n = 44). The comparison group consisted of workers from the same districts working under the usual HCS system (baseline n = 72). Next, a qualitative study was conducted in workers from the intervention group in winter 2021-2022 (n = 10). RESULTS The pre-post study results yielded positive changes for the intervention group in social support and autonomy, as well as in many of the employment conditions. This group also experienced increases in psychological demands, painful positions, fatigue and psychological distress. Two main themes affecting workers' well-being emerged from the interviews: factors inherent to the self-management model and external factors. CONCLUSIONS Health and well-being outcomes seem to depend on the balance between job demands, resources, and ways of channelling conflicts within teams.
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Affiliation(s)
- Laia Ollé-Espluga
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | | | - Lluís Torrens Mèlich
- Directorate for Social Innovation, Area of Social Rights, Global Justice, Feminisms and LGTBI, Barcelona City Council, Barcelona, Spain
- Secretary of Social Affairs and Families, Generalitat de Catalunya, Barcelona, Spain
| | - Marta Juan Serra
- Directorate for Social Innovation, Area of Social Rights, Global Justice, Feminisms and LGTBI, Barcelona City Council, Barcelona, Spain
| | - Maria Marta Arcas
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Servei de Qualitat, Docència i Recerca, Fundació Sanitària Mollet, Mollet del Vallès, Barcelona, Spain
| | - Imma Cortès-Franch
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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Chen W, Xu W, Chen Y, Xu C, Zheng J, Zou Y, Zhou B. Job satisfaction and turnover of the first group of rural-oriented tuition-waived medical students in Guangxi, China: a mixed-method study. BMC PRIMARY CARE 2024; 25:237. [PMID: 38965480 PMCID: PMC11225299 DOI: 10.1186/s12875-024-02486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND In 2010, China launched a rural-oriented tuition-waived medical education (RTME) programme to train more general practitioners (GPs) to meet the needs of the rural health workforce. Motivating and maintaining GPs is an important consideration for the shortage in the rural health workforce. This study aimed to investigate job satisfaction and turnover among the first group of rural-oriented tuition-waived medical students (RTMSs) who had completed a three-year compulsory service in Guangxi, as well as the factors affecting RTMSs turnover. METHODS This study adopted a mixed-method approach. A quantitative survey of 129 RTMSs was analysed (81.6% response rate), and qualitative interviews were conducted with 30 stakeholders, including 18 RTMSs, six administrators of the County Health Bureau, and six administrators of township health centers (THCs). A t-test, chi-square test, Fisher's exact test, and logistic regression analysis were used to examine the quantitative data, and thematic analysis was used to analyse the qualitative data. RESULTS Among the 129 participants, the turnover rate was high, with 103 RTMSs reporting turnover (79.84%). Interpersonal relationships scored the highest in job satisfaction (3.63 ± 0.64) among RTMSs, while working conditions were rated the lowest (2.61 ± 0.85). Marital status (odds ratio [OR] = 0.236, 95% confidence interval [95%CI] = 0.059-0.953, P = 0.043), only child status (OR = 8.660, 95%CI = 1.714-43.762, P = 0.009), and job return satisfaction (OR = 0.290, 95%CI = 0.090-0.942, P = 0.039) were significantly associated with turnover. Univariate analyses showed that income had a significant influence on turnover, but the relationship gone by multivariable; however it was deemed important in the qualitative study. Qualitative analysis revealed that turnover was influenced by the working atmosphere, effort-reward imbalance, professional competence, and opportunities for training and promotion. CONCLUSIONS This study provides insights for the policymakers about the priority areas for retaining GPs in rural locations and provides reference values for the retention of GPs in other regions with a shortage of rural health workers. For RTMSs to continue providing services to rural areas, the government should improve their salaries, balance their income and workload, provide more opportunities for training and career promotion, and managers should recognise their efforts and create an optimistic working atmosphere.
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Affiliation(s)
- Wenxu Chen
- School of Information and Management, Guangxi Medical University, Guangxi, 530021, China
| | - Wenjia Xu
- Liuzhou People's Hospital, Liuzhou, Guang xi, 545000, China
| | - Yanhua Chen
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Chengying Xu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jiahui Zheng
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Yunfeng Zou
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Bo Zhou
- School of Information and Management, Guangxi Medical University, Guangxi, 530021, China.
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Möckli N, Simon M, Denhaerynck K, Trutschel D, Martins T, Meyer-Massetti C, Zúñiga F. How external and agency characteristics are related to coordination in homecare - findings of the national multicenter, cross-sectional SPOT nat study. BMC Health Serv Res 2024; 24:367. [PMID: 38519949 PMCID: PMC10960419 DOI: 10.1186/s12913-024-10751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Homecare client services are often distributed across several interdependent healthcare providers, making proper care coordination essential. However, as studies exploring care coordination in the homecare setting are scarce, serious knowledge gaps exist regarding how various factors influence coordination in this care sector. To fill such gaps, this study's central aim was to explore how external factors (i.e., financial and regulatory mechanisms) and homecare agency characteristics (i.e., work environment, workforce, and client characteristics) are related to care coordination in homecare. METHODS This analysis was part of a national multicentre, cross-sectional study in the Swiss homecare setting that included a stratified random sample of 88 Swiss homecare agencies. Data were collected between January and September 2021 through agency and employee questionnaires. Using our newly developed care coordination framework, COORA, we modelled our variables to assess the relevant components of care coordination on the structural, process, and outcome levels. We conducted both descriptive and multilevel regression analyses-with the latter adjusting for dependencies within agencies-to explore which key factors are associated with coordination. RESULTS The final sample size consisted of 1450 employees of 71 homecare agencies. We found that one explicit coordination mechanism ("communication and information exchange" (beta = 0.10, p <.001)) and four implicit coordination mechanisms-"knowledge of the health system" (beta = -0.07, p <.01), "role clarity" (beta = 0.07, p <.001), "mutual respect and trust" (beta = 0.07, p <.001), and "accountability, predictability, common perspective" (beta = 0.19, p <.001)-were significantly positively associated with employee-perceived coordination. We also found that the effects of agency characteristics and external factors were mediated through coordination processes. CONCLUSION Implicit coordination mechanisms, which enable and enhance team communication, require closer examination. While developing strategies to strengthen implicit mechanisms, the involvement of the entire care team is vital to create structures (i.e., explicit mechanisms) that enable communication and information exchange. Appropriate coordination processes seem to mitigate the association between staffing and coordination. This suggests that they support coordination even when workload and overtime are higher.
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Affiliation(s)
- Nathalie Möckli
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Michael Simon
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Diana Trutschel
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Tania Martins
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology & Toxicology, Department of General Internal Medicine, Inselspital - University Hospital Bern, CH-3010, Freiburgstrasse, Bern, Switzerland
- Institute for Primary Health Care BIHAM, University of Bern, Mittelstrasse 30, CH-3012, Bern, Switzerland
| | - Franziska Zúñiga
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland.
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Markkanen PK, Gore RJ, Sama SR, Lindberg JE, Galligan CJ, Quinn MM. Coaching Home Care Clients to Prepare Their Homes for Safe Care Visits: A Mixed-Methods Study to Evaluate a Nurse-Led Educational Intervention Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:360. [PMID: 38541359 PMCID: PMC10970455 DOI: 10.3390/ijerph21030360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
Assuring home care (HC) workers' safety is challenging because the work environment is a private home. This paper presents the process evaluation for a proof-of-concept safety intervention study to assess whether nurse-led safety coaching, using motivational interviewing and a safety handbook, could enable HC clients to improve safety in their homes. The process evaluation objectives were to (i) document the intervention's implementation progress and (ii) assess the intervention's dose delivery, dose reception, and fidelity. Five agencies employing liaisons (n = 5) and nurse managers (NMs, n = 8) implemented this study's intervention and control arms. NMs assigned to the intervention arm (n = 6) coached 34 clients. Process evaluation metrics were assessed with mixed-methods data from (i) surveys completed by NMs during the intervention, (ii) postintervention audio-recorded and transcribed interviews (n = 6) with NMs and liaisons, and (iii) study progress tracking tools. The delivered dose efficiency was 85%, measured by the distribution of safety handbook copies to clients. About 94% of clients (n = 32) were considered "engaged" or "maybe engaged" during the safety coaching. Most coached clients (n = 30) were reachable for follow-up by NMs to assess intervention progress. Despite challenges, the intervention was implemented with good fidelity. Safety coaching can be applied in many HC contexts in larger populations.
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Affiliation(s)
- Pia K. Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Rebecca J. Gore
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
- Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA
| | - Susan R. Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - John E. Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Catherine J. Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Margaret M. Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
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FitzGerald C, Moynan E, Lavelle C, O’Neill C, Robinson K, Boland P, Meskell P, Galvin R. Exploring the Impact of COVID-19 on Home Care Workers: A Qualitative Study. Gerontol Geriatr Med 2024; 10:23337214231222114. [PMID: 38250568 PMCID: PMC10799579 DOI: 10.1177/23337214231222114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
This qualitative study aimed to gain insight into the impact of COVID-19 on Home Care Workers (HCWs). During COVID-19 HCWs provided a lifeline for home care clients to support older people remaining living in their own homes. With a high-risk client base, HCWs were one of the few (Health and Social Care Professional) HSCPs to continue providing home-based care throughout COVID-19. Despite these contributions HCWs provided for aging in place during COVID-19, a paucity of research exists in relation to the challenges and impact of the pandemic on HCWs. Three in-person focus groups were conducted (n = 23). Two main themes were produced guided by a Reflexive Thematic Analysis approach to enable the researchers to best represent the participants experiences: Challenges and concerns to the personal and private lives of HCWs and Navigating home-based complexities of HCWs workplace during COVID-19. health care challenges to minimize impact to HCWs issues to create a safe workplace for HCWs.
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Affiliation(s)
| | - Eva Moynan
- School of Allied Health, University of Limerick, Ireland
| | | | | | - Katie Robinson
- School of Allied Health, University of Limerick, Ireland
| | - Pauline Boland
- School of Allied Health, University of Limerick, Ireland
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Ireland
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Väisänen V, Ruotsalainen S, Säynäjäkangas P, Mänttäri S, Laitinen J, Sinervo T. Effects of workday characteristics and job demands on recovery from work among Finnish home care nurses: a multi-source cross-sectional study. Int Arch Occup Environ Health 2024; 97:65-74. [PMID: 38032508 DOI: 10.1007/s00420-023-02026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Ageing populations and poor care workforce availability are causing increasing job demands for home care nurses across Europe. While recovery from work helps sustain work ability and wellbeing, past research has relied mainly on self-reported measures of health, stressors, and recovery. This study aims to examine how objective and subjective job demands are associated with measured day-time recovery among home care nurses. METHODS Heart rate variability recording was conducted for 95 Finnish home care nurses. The study participants documented their work tasks throughout the workday and filled a wellbeing questionnaire. The amount of care time, breaktime, number of different weekly clients, and their care needs were obtained from the survey. The associations between job demands and measured day-time recovery were analysed using multivariate linear regression. RESULTS The amount of day-time recovery was on average 75 min. The number of different clients during the workday (e.g., care continuity) and higher care needs of the clients were associated with lower day-time recovery. Additionally, something slightly disrupting the course of the workday was associated with increased recovery. CONCLUSIONS Our findings indicate that reducing especially the objective job demands (workday characteristics) can contribute to better day-time recovery among home care nurses. To help sustain work ability and improve wellbeing, day-time recovery can be promoted with better work scheduling that supports care continuity and ensures sufficient care resources and support for nurses with many clients or clients with high care needs.
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Affiliation(s)
- Visa Väisänen
- Finnish Institute for Health and Welfare, Helsinki, Finland.
| | | | | | - Satu Mänttäri
- Finnish Institute of Occupational Health, Oulu, Finland
| | | | - Timo Sinervo
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Kelly C, Dansereau L, Sebring JCH, Lee Y, Williams A. Wages or Legitimacy? A Qualitative Analysis of Home Care Worker Perspectives in Choosing Work Settings. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241248094. [PMID: 38842193 PMCID: PMC11160113 DOI: 10.1177/00469580241248094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 06/07/2024]
Abstract
Directly-Funded (DF) home care allows users to organize and purchase their own care services and is expanding globally. Little is known about the career pathways of home care workers. Our study asks, what experiences and factors do home care workers consider when choosing a work setting? And, specifically, what influences their decisions to work directly for their clients? Framed with Cranford's (2020) flexibility-security matrix for analyzing home care dynamics, we remotely interviewed 20 home care workers in two Canadian provinces. Three team members conducted axial coding and thematic analysis using Dedoose software. We identified personal and material factors at the intimate and labor market level that workers weigh when choosing whether to work for an agency or directly for a client. At the intimate level, workers value the flexibility, autonomy, and respect facilitated in care relations when working directly for a client. At the labor market level, agencies provide better job security and the benefit of supervisory support but lower wages. Additionally, as care work often serves as a stepping stone for immigration and citizenship agency positions are considered a more "legitimate" option than working directly for a client. Our study shows that workers directly employed by their clients enjoy more flexibility but lack security, whereas agency employed workers risk immediate reductions in working conditions in exchange for limited improvements in safety and supervision and, like other frontline care work, DF home care represents a key career pathway for immigrants with previous experience in health and social care settings.
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Affiliation(s)
| | | | | | - Yeonjung Lee
- Chung-Ang University, Seoul, South Korea
- University of Calgary, Calgary, AB, Canada
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van der Steen MP. Entrepreneurship in care for elderly people with dementias: situated responses to NPM-based healthcare reforms in the Netherlands. BMC Health Serv Res 2023; 23:1349. [PMID: 38049813 PMCID: PMC10694910 DOI: 10.1186/s12913-023-10351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate "healthcare entrepreneurship", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer's disease. METHODS A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have. RESULTS The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship - two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level. CONCLUSION Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing.
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Kaihlanen AM, Ruotsalainen S, Väisänen V, Corneliusson L, Pesonen T, Sinervo T. Job demand and job resource factors explaining stress and job satisfaction among home care nurses - a mixed-methods sequential explanatory study. BMC Nurs 2023; 22:404. [PMID: 37891583 PMCID: PMC10612316 DOI: 10.1186/s12912-023-01568-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Increasing home care has been seen as a way to respond to the growing care needs of the aging population. To secure a sufficient number of nurses to provide home care, it is essential to identify and take into account the factors related to their well-being and job satisfaction. This study examined associations of both objective and subjective job demands and resources with stress and job satisfaction among nurses working in home care. METHODS This study used a mixed-methods sequential explanatory design. First, quantitative data was collected with a survey, followed by a qualitative survey with open-ended questions. Linear regression analyses and qualitative content analysis with an inductive approach were used to analyze the quantitative and qualitative data, respectively. Joint display in a form of a table was used to integrate the results. RESULTS Of the objectively measured job demands and resources, higher proportion of direct care time and higher number of interruptions were associated with higher stress in the fully adjusted models. Of the subjective measures, higher time pressure, role conflicts and disruptions were associated with higher stress. Higher time pressure, role conflicts, and disruptions in the workday were associated with lower job satisfaction, whereas higher care continuity and having more autonomy were associated with higher job satisfaction. The results of the qualitative study, in which the nurses described their experiences of their working week, partly explained and confirmed the results of the quantitative study but were also contradictory in some respects. CONCLUSIONS Many demands, both subjectively experienced and objectively measured in terms of work organization, may undermine home care nurses' well-being and enjoyment at work. A severe nursing shortage combined with a growing number of clients is the reality of home care, significantly increasing the risk of burnout and turnover among employees. Strategies must be developed urgently to ensure sufficient personnel in home care. For example, investments should be made in opportunities for autonomous planning of work, and promotion of good cooperation and functionality of work teams.
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Affiliation(s)
- Anu-Marja Kaihlanen
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland.
| | - Salla Ruotsalainen
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
| | - Visa Väisänen
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
| | - Laura Corneliusson
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
| | - Tiina Pesonen
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
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Gebhard D, Herz M. How to Address the Health of Home Care Workers: A Systematic Review of the Last Two Decades. J Appl Gerontol 2023; 42:689-703. [PMID: 36440715 PMCID: PMC9996797 DOI: 10.1177/07334648221141084] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Making home care a healthy workplace is a societal concern but research on specific interventions is still scarce. The aim of this systematic review was to provide an initial overview of interventions addressing home care workers' health. All (quasi-) experimental studies, presenting any intervention among home care employees, and reporting any outcome related to occupational health, safety, or well-being were included. PsycArticles, Medline, PubMed, and Web of Science were searched from January 2000 to February 2022. From 16,345 publications, 18 studies with 2432 participants were included and assessed with the Joanna Briggs Institute Critical Appraisal Tools. Organizational and training/educational approaches were found in five studies each, a behavioral approach in one, and seven studies presented a combined approach. Due to methodological limitations and the heterogeneity of interventions, the existing studies are insufficient to inform new programs, but emphasize the need for tailored approaches, integrated concepts, and participatory intervention development.
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Affiliation(s)
- Doris Gebhard
- Department of Sport and Health Sciences, 9184Technical University of Munich, Germany
| | - Michael Herz
- Department of Sport and Health Sciences, 9184Technical University of Munich, Germany
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Tangchitnusorn K, Prachuabmoh V. Motivation and Quality of Work Life of In-Home Paid Caregivers of Older Adults. J Appl Gerontol 2023; 42:737-746. [PMID: 36513623 DOI: 10.1177/07334648221145167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hiring in-home paid caregivers (IPCs) to tend to older adults at home has been one of the popular long-term care strategies in several urban aging societies. Relevant studies in the Global South that provide empirical findings have been lacking. This study contributes to the literature on home care by conducting a qualitative analysis of work motivation and the quality of work life of female IPCs in Thailand. We found that work motivation involved the desire for personal economic improvement and the search for an emotional anchor. Analysis of quality of work life pointed to three major themes: great contribution but low recognition and support; interdependence as an ultimate career goal; and effective training as a key to opportunity and success. We proposed a theoretical extension to the existing care theories and suggested necessary policy interventions to sustain the supply of IPCs.
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Affiliation(s)
| | - Vipan Prachuabmoh
- College of Population Studies, 197948Chulalongkorn University, Bangkok, Thailand
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13
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Gebhard D, Wimmer M. The Hidden Script of Work-Related Burdens in Home Care - A Cross Over Mixed Analysis of Audio Diaries. J Appl Gerontol 2023; 42:704-716. [PMID: 36280591 PMCID: PMC9996799 DOI: 10.1177/07334648221130747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The lived experiences of work-related burdens in the daily working routines of home care workers are insufficiently investigated. Therefore, the aim of this study is to examine the types, frequencies, and distributions of work-related burdens and to explore their co-occurrence. Qualitative data was collected via audio diaries and analyzed applying a crossover mixed analysis using content as well as network analysis. In all, 23 home care workers (mean age = 46.70 ± 10.40; 91.30% female) produced 242 diary entries. Participants reported work-related burdens 580 times with 77 different types, predominately in relation to work organization (50.5%). Network analysis reveals a complex picture, which shows the strong relation between time pressure and travel between homes, and identifies additional tasks as the central node in the network of burdens. A holistic understanding of setting-specific burdens provides an important starting point for measures of workplace health promotion.
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Affiliation(s)
- Doris Gebhard
- Department of Sport and Health Sciences, 9184Technical University of Munich, Munich, Germany
| | - Magdalena Wimmer
- Department of Sport and Health Sciences, 9184Technical University of Munich, Munich, Germany
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Ruotsalainen S, Elovainio M, Jantunen S, Sinervo T. The mediating effect of psychosocial factors in the relationship between self-organizing teams and employee wellbeing: A cross-sectional observational study. Int J Nurs Stud 2023; 138:104415. [PMID: 36527858 DOI: 10.1016/j.ijnurstu.2022.104415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Several benefits of working in a self-organizing team, such as higher job satisfaction and better engagement to work have been demonstrated in previous studies. OBJECTIVE To examine whether those employees working in a self-organizing team have higher job satisfaction and lower turnover intentions compared to those in non-self-organized teams. Further, to test whether psychosocial factors defined by the Job Demand-Control model would function as mediators. DESIGN A cross-sectional survey study. SETTING(S) Home care and assisted living facilities (with 24-h assistance). PARTICIPANTS Licensed practical nurses (N = 377), registered nurses, therapists and managers (N = 183), and other employees (N = 31) in services for older people. METHODS A survey for employees working in services for older people and who were either in the self-organized teams or in the non-self-organized teams. Data was analyzed using linear regression and mediation analyses. RESULTS Those employees who worked in a self-organizing team were more satisfied with their job and had lower turnover intentions compared to those in a non-self-organizing team (mean [SD] 3.9 [1.0] vs. 3.7 [1.0], p = 0.006 and 2.2 [1.2] vs. 2.5 [1.3], p = 0.006, respectively). Moreover, job demands and job strain partially mediated the effect of self-organizing teamwork on job satisfaction (Average causal mediation effect [95%CI] 0.09 [0.02-0.15] and 0.10 [0.03-0.18], respectively), as well as on turnover intentions (Average causal mediation effect [95%CI] -0.08 [-0.15 to -0.01] and -0.20 [-0.18 to -0.03], respectively). CONCLUSIONS In the context of older people care services, working in self-organizing teams may enhance employee wellbeing by lowering job demands and job strain, but not by improving job control. Based on the findings of this study, self-organization seems beneficial, however, it requires real autonomy for the teams and team building. TWEETABLE ABSTRACT Self-organizing teamwork increases job satisfaction and decreases turnover intentions via lower job demands and strain in older people care.
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Affiliation(s)
- Salla Ruotsalainen
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Helsinki, Finland.
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Helsinki, Finland; Research Program Unit, Faculty of Medicine, University of Helsinki, Finland
| | - Sami Jantunen
- South-Eastern Finland University of Applied Sciences, RDI and Services, Digital Economy Focus Area, Mikkeli, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Helsinki, Finland
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15
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Kiljunen O, Kankkunen P, Välimäki T. Identification of Contributing Factors of Falls and Non-Fall Accidents Among Home Care Clients: A Retrospective Study Using Incident Reports. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221134095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To prevent falls and other accidents among home care clients, it is essential to gather high-quality information on the factors contributing to the accidents. Incident reporting systems are used in home care units to generate information for risk management. This study aimed to explore the contributing factors of falls and non-fall accidents among home care clients and to evaluate the accuracy of the information on contributing factors gained from the incident reporting system. An existing dataset was used—safety incident reports concerning accidents involving home care clients. The incident reports (n = 323) were stored in the social- and health care organization’s incident reporting database from 2018 to 2020. The free-text narratives describing factors contributing to the event’s occurrence were analyzed using inductive content analysis, and the frequencies of the main category codes were recorded. The results were then compared with the frontline managers’ analyses of the narratives, where the managers used the classification of contributing factors provided by the system. According to incident reports, intrinsic (person-specific), behavior-related and extrinsic (environment-related) factors contributed to accidents among home care clients. Intrinsic and behavior-related factors were reported more often than extrinsic factors. The classified information on contributing factors did not correspond in all respects to the descriptions in the incident reports. To ensure high-quality information for safety management, incident reporting tools must be appropriate for use in the home care context. Both the reporter of an adverse event and the individual responsible for analyzing the report play essential roles in identifying contributing factors of accidents.
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Affiliation(s)
- Outi Kiljunen
- University of Eastern Finland, Department of Nursing Science, Kuopio, Finland
| | - Päivi Kankkunen
- University of Eastern Finland, Department of Nursing Science, Kuopio, Finland
| | - Tarja Välimäki
- University of Eastern Finland, Department of Nursing Science, Kuopio, Finland
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16
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Hult M, Saaranen T, Lindström PN. Calling as a resource for health and occupational wellbeing among the care sector workers in Finland. Work 2022; 74:723-732. [PMID: 36314183 DOI: 10.3233/wor-211326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The salutogenic approach in workplace health promotion emphasizes resources to gain and maintain good health and wellbeing. One of these resources could be calling, but its relation to the salutogenic approach is unknown. OBJECTIVE To explore the associations between salutogenic measures of health and occupational wellbeing and calling among workers from the care and educational sectors. METHODS A cross-sectional survey was conducted in Autumn 2020 among Finnish public and private sector care workers. A total of 7925 workers responded. Descriptive analyses and analysis of variance were used for the data analysis. RESULTS Salutogenic measures of health and occupational wellbeing correlated strongly mutually, and both correlated moderately with calling. Workers aged over 55 years, workers acting in the education sector, workers with superior positions and temporary workers had the highest scores on health, occupational wellbeing and calling. When comparing occupational wellbeing dimensions by profession, managers had the highest scores and nurses the lowest. CONCLUSIONS This study provides knowledge of promotive factors and health and occupational wellbeing resources for workplace health promotion in the care sector. Perceived calling in work can be considered a salutogenic resource for overall health and wellbeing; however, these connections should be further studied.
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Affiliation(s)
- Marja Hult
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Terhi Saaranen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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de Bruin J, Doodkorte R, Sinervo T, Clemens T. The implementation and outcomes of self-managing teams in elderly care: A scoping review. J Nurs Manag 2022; 30:4549-4559. [PMID: 36192833 PMCID: PMC10092661 DOI: 10.1111/jonm.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/07/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIM We aim to map the existing evidence and gaps in research on the implementation and outcomes of self-managing elderly care teams. BACKGROUND Due to increasing demand for elderly nursing care and an ageing workforce, recruiting and retaining community nurses have become challenging. Implementing self-managing teams may be a solution to address this problem. EVALUATION This scoping review included 27 studies, varying from narrative reviews to a quantitative cross-sectional study. The studies' primary focus on self-managing teams was essential for eligibility. KEY ISSUES Nurses' job satisfaction was high in self-managing teams due to improved relationships with patients and increased autonomy. Continuity of care and patient acceptability were high. Transformation of managers to coaches in a team with a flat hierarchy is needed to empower nurses with responsibility for their own work. Trust and teamwork should be assisted by suitable ICT support systems. CONCLUSIONS International interest in self-managing teams is large, but quantitative research is limited and guidelines for implementation are needed. Recommendations for potential successful implementation were made. IMPLICATIONS FOR NURSING MANAGEMENT Nurse autonomy and job satisfaction can increase by implementing self-managing teams. This requires a change in management styles, from managing to coaching nurses.
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Affiliation(s)
- Jeanine de Bruin
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Remco Doodkorte
- Department of Experimental Orthopedics, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Timo Sinervo
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Timo Clemens
- Department of International Health. CAPHRI - Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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18
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Daouda OS, Bun RS, Ait Bouziad K, Miliani K, Essa-Eworo A, Espinasse F, Seytre D, Casetta A, Nérome S, Nascimento A, Astagneau P, Temime L, Hocine MN. Multilevel approach to individual and organisational predictors of stress and fatigue among healthcare workers of a university hospital: a longitudinal study. Occup Environ Med 2022; 79:oemed-2022-108220. [PMID: 35981866 PMCID: PMC9685720 DOI: 10.1136/oemed-2022-108220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Healthcare workers (HCWs) are at high risk of experiencing stress and fatigue due to the demands of their work within hospitals. Improving their physical and mental health and, in turn, the quality and safety of care requires considering factors at both individual and organisational/ward levels. Using a multicentre prospective cohort, this study aims to identify the individual and organisational predictors of stress and fatigue of HCWs in several wards from university hospitals. METHODS Our cohort consists of 695 HCWs from 32 hospital wards drawn at random within four volunteer hospital centres in Paris-area. Three-level longitudinal analyses, accounting for repeated measures (level 1) across participants (level 2) nested within wards (level 3) and adjusted for relevant fixed and time-varying confounders, were performed. RESULTS At baseline, the sample was composed by 384 registered nurses, 300 auxiliary nurses and 11 midwives. According to the three-level longitudinal models, some predictors were found in common for both stress and fatigue (low social support from supervisors, work overcommitment, sickness presenteeism and number of beds per ward). However, specific predictors for high level of stress (negative life events, low social support from colleagues and breaks frequently cancelled due to work overload) and fatigue (longer commuting duration, frequent use of interim staff in the ward) were also found. CONCLUSION Our results may help identify at-risk HCWs and wards, where interventions to reduce stress and fatigue should be focused. These interventions could include manager training to favour better staff support and overall safety culture of HCWs.
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Affiliation(s)
- Oumou Salama Daouda
- MESuRS Laboratory, Conservatoire National des Arts et Metiers, Paris, Île-de-France, France
| | - René Sosata Bun
- iPLESP, INSERM, Sorbonne Universite, Paris, Île-de-France, France
| | - Karim Ait Bouziad
- MESuRS Laboratory, Conservatoire National des Arts et Metiers, Paris, Île-de-France, France
| | | | | | | | | | - Anne Casetta
- Hôpital Cochin, AP-HP, Paris, Île-de-France, France
| | - Simone Nérome
- Hôpital Beaujon, AP-HP, Paris, Île-de-France, France
| | - Adelaide Nascimento
- CRTD Laboratory, Conservatoire National des Arts et Metiers, Paris, Île-de-France, France
| | - Pascal Astagneau
- iPLESP, INSERM, Sorbonne Universite, Paris, Île-de-France, France
- CPIAS Ile de France, Paris, Île-de-France, France
| | - Laura Temime
- MESuRS Laboratory, Conservatoire National des Arts et Metiers, Paris, Île-de-France, France
| | - Mounia N Hocine
- MESuRS Laboratory, Conservatoire National des Arts et Metiers, Paris, Île-de-France, France
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Hapsari AP, Ho JW, Meaney C, Avery L, Hassen N, Jetha A, Lay AM, Rotondi M, Zuberi D, Pinto A. The working conditions for personal support workers in the Greater Toronto Area during the COVID-19 pandemic: a mixed-methods study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:817-833. [PMID: 35616873 PMCID: PMC9134716 DOI: 10.17269/s41997-022-00643-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE During the height of the COVID-19 pandemic, personal support workers (PSWs) were heralded as healthcare 'heroes' as many of them cared for high-risk, vulnerable older populations, and worked in long-term care, which experienced a high number of COVID-19 outbreaks and deaths. While essential to the healthcare workforce, there is little understanding of PSW working conditions during the pandemic. The aim of our study was to examine the working conditions (including job security, work policies, and personal experiences) for PSWs in the Greater Toronto Area during the COVID-19 pandemic from the perspectives of PSWs. METHODS This study used a mixed-methods design. From June to December 2020, we conducted a survey of 634 PSWs to understand their working conditions during the COVID-19 pandemic. Semi-structured interviews with 31 survey respondents were conducted from February to May 2021 to understand in greater depth how working conditions were impacting the well-being of PSWs. RESULTS We found PSWs faced a range of challenges related to COVID-19, including anxiety about contracting COVID-19, reduced work hours, taking leaves of absences, concerns about job security, and losing childcare. While the COVID-19 pandemic highlighted the PSW workforce and their importance to the healthcare system (especially in the long-term care system), pre-existing poor work conditions of insecure jobs with no paid sick days and benefits exacerbated COVID-19-related challenges. Despite these hardships, PSWs were able to rely on their mental resilience and passion for their profession to cope with challenges. CONCLUSION Significant changes need to be made to improve PSW working conditions. Better compensation, increased job security, decreased workload burden, and mental health supports are needed.
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Affiliation(s)
- Ayu Pinky Hapsari
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Julia W. Ho
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,Department of Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, ON Canada
| | - Nadha Hassen
- Faculty of Environmental and Urban Change, York University, Toronto, ON Canada
| | - Arif Jetha
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,Institute for Work and Health, Toronto, ON Canada
| | - A. Morgan Lay
- Institute of Population and Public Health, Canadian Institutes of Health Research, Toronto, ON Canada
| | - Michael Rotondi
- School of Kinesiology and Health Science, York University, Toronto, ON Canada
| | - Daniyal Zuberi
- Munk School of Global Affairs & Public Policy, University of Toronto, Toronto, ON Canada ,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON Canada
| | - Andrew Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada ,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
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20
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Pinto AD, Hapsari AP, Ho J, Meaney C, Avery L, Hassen N, Jetha A, Lay AM, Rotondi M, Zuberi D. Precarious work among personal support workers in the Greater Toronto Area: a respondent-driven sampling study. CMAJ Open 2022; 10:E527-E538. [PMID: 35700996 PMCID: PMC9343122 DOI: 10.9778/cmajo.20210338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the role of personal support workers (PSWs) in health care, as well as their work conditions. Our study aimed to understand the characteristics of the PSW workforce, their work conditions and their job security, as well as to explore the health of PSWs and the impact of precarious employment on their health. METHODS Our community-based participatory action research focused on PSWs in the Greater Toronto Area. We administered an online, cross-sectional survey between June and December 2020 using respondent-driven sampling. Data on sociodemographics, employment precarity, worker empowerment and health status were collected. We assessed the association between precarious employment and health using multivariable logistic regression models. RESULTS We contacted 739 PSWs, and 664 consented to participate. Overall, 658 (99.1%) completed at least part of the survey. Using data adjusted for our sampling approach, the participants were predominantly Black (76.5%, 95% confidence interval [CI] 68.2%-84.9%), women (90.1%, 95% CI 85.1%-95.1%) and born outside of Canada (97.4%, 95% CI 94.9%-99.9%). Most worked in home care (43.9%, 95% CI 35.2%-52.5%) or long-term care (34.5%, 95% CI 27.4%-42.0%). Although most participants had at least some postsecondary education (unadjusted proportion = 83.4%, n = 529), more than half were considered low income (55.1%, 95% CI 46.3%-63.9%). Most participants were precariously employed (86.5%, 95% CI 80.7%-92.4%) and lacked paid sick days (89.5%, 95% CI 85.8%-93.3%) or extended health benefits (74.1%, 95% CI 66.8%-81.4%). Nearly half of the participants described their health as less than very good (46.7%, 95% CI 37.9%-55.5%). Employment precarity was significantly associated with higher risk of depression (odds ratio 1.02, 95% CI 1.01-1.03). INTERPRETATION Despite being key members of health care teams, most PSWs were precariously employed with low wages that keep them in poverty; the poor work conditions they faced could be detrimental to their physical and mental health. Equitable strategies are needed to provide decent work conditions for PSWs and to improve their health.
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Affiliation(s)
- Andrew D Pinto
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont.
| | - Ayu P Hapsari
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Julia Ho
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Christopher Meaney
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Lisa Avery
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Nadha Hassen
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Arif Jetha
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - A Morgan Lay
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Michael Rotondi
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Daniyal Zuberi
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
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Ciasullo MV, Douglas A, Palumbo R. Empowering or addicting? An analysis of the effects of team members–supervisor relationships on job satisfaction in healthcare. JOURNAL OF GENERAL MANAGEMENT 2022. [DOI: 10.1177/03063070211035728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient-centredness relies on integrated care, which requires teamwork to be effectively implemented. Positive relationships between team members and supervisors are crucial to enhance health professionals’ satisfaction with their job and, consequently, to increase their commitment to organizational excellence. However, the positive effects of team members–supervisor exchange may dilute when the team is endowed with autonomy at work. The article proposes a moderation analysis aimed at collecting evidence of the implications of team members–supervisor relationships on job satisfaction (JS) with team autonomy (TA) as a moderating variable. Results of the study suggest that positive exchanges between team members and supervisors enhance health professionals’ satisfaction with their job. However, TA acts as a negative and statistically significant moderator. Good exchanges between team members and their supervisor seem to lose their positive effects on JS when health professionals are provided with a greater self-determination to accomplish their organizational activities. Tailored management interventions should be designed to sustain teamwork when increased autonomy at work is assigned to health professionals.
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Persson J, Johansson G, Arvidsson I, Östlund B, Holgersson C, Persson R, Rydenfält C. A framework for participatory work environment interventions in home care - success factors and some challenges. BMC Health Serv Res 2022; 22:345. [PMID: 35292041 PMCID: PMC8923086 DOI: 10.1186/s12913-022-07710-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Home care is beset with work environment issues and high staff turnover, while research concerned with interventions to improve the work environment is sparse. Few of the existing interventions apply a participative approach, despite this being associated with more positive outcomes and sustainable change. This paper presents a framework, rooted in action research and action learning, for participatory work environment interventions in home care, and demonstrates how this framework has been implemented in four Swedish home care organizations. Methods The framework has three phases (pre-intervention, intervention planning and intervention implementation) and consists of cycles of action and reflection in three constellations: a group of researchers, a reference group with labour market organization representatives and home care managers, and intervention work groups in the home care organizations. The work was documented and analysed with focus on the realization of the framework and challenges that were met on the way. The interventions were evaluated using a pre-/post-test questionnaire design. Results Parts of the framework were successfully implemented. The pre-intervention phase and the intervention planning phase, with intervention work groups, worked well. All four groups identified one intervention relevant to their own context. However, only two of the proposed interventions were fully implemented and evaluated. The high staff and management turnover, and the high rate of organizational changes made it impossible to evaluate the interventions statistically. Yet, data from open-ended questions in the post questionnaire showed that the two implemented interventions were perceived as successful. Conclusions The participatory framework, presented in this paper, seems promising for work environment interventions in home care. The framework was designed to reduce the risk of known disturbances affecting the process in unstable organizations. Despite this, it proved challenging to execute the framework, and especially the interventions, due to changes happening at high speed. In the two cases where organizational changes were not dominating, the interventions were implemented successfully. While the prerequisites for participation and successful implementation could be improved somewhat, the main issue, the instability of the organizational context, is hard for researchers or the individual home care units to tackle alone.
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Affiliation(s)
- Johanna Persson
- Department of Design Sciences, Lund University, Lund, Sweden.
| | - Gerd Johansson
- Department of Design Sciences, Lund University, Lund, Sweden
| | - Inger Arvidsson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Britt Östlund
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Charlotte Holgersson
- Department of Industrial Economics and Management, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Roger Persson
- Department of Psychology, Lund University, Lund, Sweden
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Vauhkonen A, Saaranen T, Honkalampi K, Järvelin-Pasanen S, Kupari S, Tarvainen MP, Perkiö-Mäkelä M, Räsänen K, Oksanen T. Work community factors, occupational well-being and work ability in home care: A structural equation modelling. Nurs Open 2021; 8:3190-3200. [PMID: 34392605 PMCID: PMC8510720 DOI: 10.1002/nop2.1032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/14/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022] Open
Abstract
Aim To examine how work community factors are related to occupational well‐being and work ability, and how occupational well‐being is related to work ability. Design A cross‐sectional study was conducted among home care workers in one municipality in Finland. Methods A self‐administered survey on work and well‐being was filled out by 167 employees working two shifts in 2019. Structural equation modelling was used to analyse the association between work community factors, occupational well‐being and work ability. Results The only work community factor directly affecting Occupational well‐being was Information and work organization; the effect of the other two factors, Social support and Influence on work shifts, was indirect. All work community factors indirectly affected Work ability. Home care should emphasize information provision and work organization with optimal time use. This requires social support, a well‐functioning work atmosphere and providing employees with opportunities for influence and participation.
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Affiliation(s)
- Anneli Vauhkonen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Terhi Saaranen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kirsi Honkalampi
- School of Educational Sciences and Psychology, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | | | - Saana Kupari
- Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland
| | - Mika P Tarvainen
- Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Finland
| | - Merja Perkiö-Mäkelä
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kimmo Räsänen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tuula Oksanen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Franklin P, Gkiouleka A. A Scoping Review of Psychosocial Risks to Health Workers during the Covid-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2453. [PMID: 33801517 PMCID: PMC7967576 DOI: 10.3390/ijerph18052453] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
The Covid-19 pandemic has exposed health workers to a diverse set of hazards impacting their physical, psychological and social wellbeing. This review aims to provide an overview of the categories of the psychosocial risk factors and hazards affecting HCWs during the Covid-19 pandemic and the recommendations for prevention. We used the scoping review methodology to collate categories of psychosocial risks, the related health outcomes, interventions, and data gaps. The review was conducted on global peer-reviewed academic and authoritative grey literature, published between 1. January-26. October 2020; in total, 220 articles were included into the review and the subsequent analysis. Analysis of the extracted data found PSRs related to four sources: personal protective equipment (PPE), job content, work organisation, and social context. is. Women health workers and nurses reported worst health outcomes. Majority of the research to date concerns health workers in secondary care, while data on psychosocial risks at primary and community-based settings are scarce. However, the emerging research implies that the pandemic creates psychosocial risks also to non-clinical health workers. The intervention and mitigation measures address individual and organisational levels. Preventative and mitigating measures for social and societal risks-such as staff shortages, intersecting inequalities, and financial stressors require further research.
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Affiliation(s)
- Paula Franklin
- Occupational Safety & Health and Working Conditions Unit, European Trade Union Institute (ETUI), Boulevard du Roi Albert II, 1210 Brussels, Belgium
| | - Anna Gkiouleka
- Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK;
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