Registered nurses' exposure to workplace aggression in Norway: 12-month prevalence rates, perpetrators, and current turnover intention

BACKGROUND

Identifying occupational health hazards among Registered Nurses (RNs) and other health personnel and implementing effective preventive measures are crucial to the long-term sustainability of health services. The objectives of this study were (1) to assess the 12-month prevalence rates of exposure to workplace aggression, including physical violence, threats of violence, sexual harassment, and bullying; (2) to identify whether the perpetrators were colleagues, managers, subordinates, or patients and their relatives; (3) to determine whether previous exposure to these hazards was associated with RNs' current turnover intention; and (4) to frame workplace aggression from an occupational health and safety perspective.

METHODS

The third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) was used to assess RNs' exposure to workplace aggression and turnover intention. A national sample of 8,800 RNs in Norway, representative of the entire population of registered nurses in terms of gender and geography, was analysed. Binary and ordinal logistic regression analyses were conducted, and odds for exposure and intention to leave are presented, with and without controls for RNs' gender, age, and the type of health service they work in.

RESULTS

The 12-month prevalence rates for exposure were 17.0% for physical violence, 32.5% for threats of violence, 12.6% for sexual harassment, and 10.5% for bullying. In total, 42.6% of the RNs had experienced at least one of these types of exposure during the past 12 months, and exposure to more than one of these hazards was common. Most perpetrators who committed physical acts and sexual harassment were patients, while bullying was usually committed by colleagues. There was a strong statistical association between exposure to all types of workplace aggression and RNs' intention to leave. The strongest association was for bullying, which greatly increased the odds of looking for work elsewhere.

CONCLUSIONS

Efforts to prevent exposure to workplace aggression should be emphasised to retain health personnel and to secure the supply of skilled healthcare workers. The results indicate a need for improvements. To ensure the sustainability of health services, labour and health authorities should join forces to develop effective workplace measures to strengthen prevention, mitigation, and preparedness regarding incidents of workplace aggression in health services and the response and recovery regarding incidents that could not be prevented.

The Norwegian version of the Copenhagen Psychosocial Questionnaire (COPSOQ III): Initial validation study using a national sample of registered nurses

BACKGROUND

Employers are legally obligated to ensure the safety and health of employees, including the organizational and psychosocial working environment. The Copenhagen Psychosocial Questionnaire (COPSOQ III) covers multiple dimensions of the work environment. COPSOQ III has three parts: a) work environment b) conflicts and offensive behaviours and c) health and welfare. We translated all three parts into Norwegian and evaluated the statistical properties of the 28 work environment dimensions in part a), using a sample of registered nurses.

METHODS

The original English version was translated into Norwegian and back translated into English; the two versions were compared, and adjustments made. In total, 86 of 99 items from the translated version were included in a survey to which 8804 registered nurses responded. Item response theory models designed for ordinal manifest variables were used to evaluate construct validity and identify potential redundant items. A standard confirmatory factor analysis was performed to verify the latent dimensionality established in the original version, and a more exploratory factor analysis without restrictions is included to determine dependency between items and to identify separable dimensions.

RESULTS

The measure of sampling adequacy shows that the data are well suited for factor analyses. The latent dimensionality in the original version is confirmed in the Norwegian translated version and the scale reliability is high for all dimensions except 'Demands for Hiding Emotions'. In this homogenous sample, eight of the 28 dimensions are found not to be separate dimensions as items covering these dimensions loaded onto the same factor. Moreover, little information is provided at the low and high ends of exposure for some dimensions in this sample. Of the 86 items included, 14 are found to be potential candidates for removal to obtain a shorter Norwegian version.

CONCLUSION

The established Norwegian translation of COPSOQ III can be used in further research about working environment factors and health and wellbeing in Norway. The extended use of the instrument internationally enables comparative studies, which can increase the knowledge and understanding of similarities and differences between labour markets in different countries. This first validation study shows that the Norwegian version has strong statistical properties like the original, and can be used to assess work environment factors, including relational and emotional risk factors and resources available at the workplace.

Exploring workplace violence on surgical wards in Sweden: a cross-sectional study

BACKGROUND

Workplace violence is a global threat to healthcare professionals' occupational health and safety and the situation has worsened during the COVID-19 pandemic. This study aimed to explore workplace violence directed against assistant and registered nurses working on surgical wards in Sweden.

METHODS

This cross-sectional study was conducted in April 2022. Using a convenience sampling procedure, 198 assistant and registered nurses responded to an online questionnaire developed for this specific study. The questionnaire comprised 52 items and included, among other items, subscales from validated and previously used instruments. Data analysis included descriptive statistics, the chi-square test, and independent-samples t-test.

RESULTS

The most frequently reported type of workplace violence was humiliation (28.8%), followed by physical violence (24.2%), threats (17.7%), and unwanted sexual attention (12.1%). Patients and patients' visitors were reported as the main perpetrators of all kinds of exposure. Additionally, one third of the respondents had experienced humiliation from colleagues. Both threats and humiliation showed negative associations with work motivation and health (p < 0.05). Respondents classified as working in a high- or moderate-risk environment were more frequently exposed to threats (p = 0.025) and humiliation (p = 0.003). Meanwhile, half of the respondents were unaware of any action plans or training regarding workplace violence. However, of those who indicated that they had been exposed to workplace violence, the majority had received quite a lot or a lot of support, mainly from colleagues (range 70.8-80.8%).

CONCLUSION

Despite a high prevalence of workplace violence, and especially of humiliating acts, there appeared to be low preparedness within the hospital organizations to prevent and/or handle such incidents. To improve these conditions, hospital organizations should place more emphasis on preventive measures as part of their systematic work environment management. To help inform such initiatives, it is suggested that future research should focus on the identification of suitable measures regarding different types of incidents, perpetrators, and settings.

Leadership, work environment and caries prevention - what is good for the staff, is also good for the patients

OBJECTIVES

Dental caries is a health problem that can be prevented. The aim of this study is to analyse if the quality of leadership, in Swedish Public Dental Health clinics, influences the extent to which patients with caries receive preventive care, and if any such effect is mediated through a collaborative work climate, clear role expectations and a low average level of burnout among staff.

METHODS

The multilevel cross-sectional design includes work environment data from surveys of 75 general public dental clinics, register-based data on preventive measures provided to 5398 patients who received a dental filling due to a caries diagnosis, and patient demographics. Using a multilevel path analysis with logistic regression, we tested a model with one direct and three indirect pathways, controlling for the potential confounding effect of patient demographic factors.

RESULTS

Leadership quality, as assessed by the staff at the clinic, was associated with increased odds of patients with caries receiving prevention, controlling for patient demographic factors. Leadership quality was also positively related to a collaborative work climate, clear role expectations and a low average level of burnout among staff. Against expectations, however, no indirect effect from leadership quality on prevention through the other work environment factors was found.

CONCLUSIONS

In conclusion, the quality of leadership in Swedish Public Dental Health clinics was positively related to a good work environment for staff and to delivery of preventive care to patients experiencing caries.

A Quick "Environment Check" for All Ages: Validating the New Age-Inclusive Work Environments Instrument

Background and Objectives

The global aging workforce necessitates new approaches in designing work environments to cater to the needs of increasingly age-diverse work groups. The Organisation for Economic Co-operation and Development (OECD) has in reaction outlined that organizations need to provide age-inclusive work environments that support the needs of their multigenerational workforce, to ensure their sustainability and profitability. To capture the age inclusiveness of the work environment, the present study proposes and validates an age-inclusive "environment check" for organizations referred to as the Age-Inclusive Work Environment Instrument (AIWEI), which covers discrimination, inclusion, and development opportunities.

Research Design and Methods

We validate the 9-item AIWEI using cross-sectional and multilevel data from 2,892 Swedish workers across 101 workplaces who completed an online survey, using confirmatory factor analyses across young, middle-age, and older workers. Using a nomological approach, we also evaluate the concurrent validity of the AIWEI with a 2-1-1 path analysis.

Results

The factor analyses supported a 3-factor model comprising of inclusion, discrimination, and development opportunities, across 3 age groups (i.e., young, middle-age, and older workers). These 3 factors had high Intraclass Coefficient (ICC) scores showing consistency in responding in the workplace. In accordance with the nomological approach, the factors of the AIWEI were linked with Psychosocial Safety Climate, burnout, and engagement, demonstrating concurrent validity for the AIWEI.

Discussion and Implications

This new "environment check" provides a way to capture age-inclusive work environments for both younger and older workers, in an age-diverse workforce. In the validation process, age-inclusive work environments were found to exist as a group phenomenon, through shared perceptions within an organization, as well as an individual phenomenon, as experiences specific to an individual. This is important for the development and implementation of policies and strategies designed to benefit workers and organizations.

The Role of Staff-Assessed Care Quality in the Relationship between Job Demands and Stress in Human Service Work: The Example of Dentistry

The aim of this study was to investigate staff-assessed care quality at the clinic as a predictor of stress and as a moderator between job demands (quantitative demands and role conflict) and stress among dental professionals as an example of human service workers. Cross-sectional questionnaire data from 1012 dental professionals (i.e., dentists, dental hygienists and dental nurses) working at 99 clinics were analysed by confirmatory factor analysis and a two-level hierarchical linear model. Stress, quantitative demands and role conflict were measured by the Swedish standard version of COPSOQ III and care quality was measured by three proprietary items. The results showed that staff-assessed care quality at the clinic was of importance for the individual workers' experiences of stress. Furthermore, the staff's joint assessment of the care quality at the clinic mitigated the negative effect of role conflict on stress among dental nurses. These results indicate that a high level of staff-assessed care quality at the clinic can contribute to reduced stress in dental professionals.

Workplace violence from the perspective of hospital ward managers in Sweden: A qualitative study

AIM

The aims of the study are to explore workplace violence perpetrated by patients or visitors from the perspective of hospital ward managers and to describe how ward managers perceive their leadership role and manage related incidents.

BACKGROUND

Few studies focus on workplace violence from the perspective of ward managers even though they are the closest managers to the operational staff.

METHOD

Fifteen semistructured interviews were analysed using qualitative content analysis.

RESULTS

Four categories emerged: the face of workplace violence, a two-fold assignment, strive towards readiness to act, and managing incidents.

CONCLUSION

While the most common acts of workplace violence are considered less serious and related to patients' medical conditions or dissatisfied visitors, hospital organizations focus on serious but rarely occurring incidents. Consequently, ward managers have limited opportunities to ensure a safe work environment on an everyday basis.

IMPLICATIONS FOR NURSING MANAGEMENT

To support ward managers' occupational safety and health management, workplace violence prevention and management should be acknowledged as an important responsibility for senior management in hospitals. It is important to identify incidents that most likely will occur at the wards and to create strategies related to those incidents. Strategies could include risk assessments, prevention, evaluation, education and reflection combined with, for example, scenario training.

Does workplace social capital predict care quality through job satisfaction and stress at the clinic? A prospective study

Background

Welfare societies like Sweden face challenges in balancing the budget while meeting the demand for good quality healthcare. The aim of this study was to analyse whether care quality, operationalized as survival of dental fillings, is predicted by workplace social capital and if this effect is direct or indirect (through stress and/or job satisfaction among staff at the clinic), controlling for patient demographics.

Methods

The prospective design includes A) work environment data from surveys of 75 general public dental clinics (aggregated data based on 872 individual ratings), and B) register-based survival of 9381dental fillings performed during a 3-month period around the time of the survey, and C) patient demographics (age, gender, income level and birth place). Using a multi-level discrete-time proportional hazard model, we tested whether clinic-level social capital, stress, and job satisfaction could predict tooth-level filling failure, controlling for patient demographics. One direct and two indirect pathways, moderated by filling tooth, location, and filling type, were tested.

Results

High workplace social capital reduced the risk of early failure of fillings in molar teeth, mediated by group-perceived job satisfaction (indirect path: OR = 0.93, p < .05, direct path from job satisfaction: OR = 0.89, p < .05). Contrary to expectations, we found no support for a direct effect from social capital on care quality or for the indirect pathway via stress at the clinic level.

Conclusions

Workplace social capital boosted the quality of dental fillings through increased levels of job satisfaction. In addition, staff at clinics with higher social capital reported less stress and higher levels of job satisfaction. These results indicate that promotion of social capital may improve both occupational health and care quality.

Benchmarks for Evidence-Based Risk Assessment with the Swedish Version of the 4-Item Psychosocial Safety Climate Scale

The purpose of the present study was to validate the short version of The Psychosocial Safety Climate questionnaire (PSC-4, Dollard, 2019) and to establish benchmarks indicating risk levels for use in Sweden. Cross-sectional data from (1) a random sample of employees in Sweden aged 25–65 years (n = 2847) and (2) a convenience sample of non-managerial employees from 94 workplaces (n = 3066) were analyzed. Benchmarks for three PSC risk levels were developed using organizational compliance with Occupational Safety and Health (OSH) regulations as criterion. The results support the validity and usefulness of the Swedish PSC-4 as an instrument to indicate good, fair, and poor OSH practices. The recommended benchmark for indicating good OSH practices is an average score of >12.0, while the proposed cutoff for poor OSH practices is a score of ≤8.0 on the PSC-4. Scores between these benchmarks indicate fair OSH practices. Furthermore, aggregated data on PSC-4 supported its reliability as a workplace level construct and its association with quantitative demands, quality of leadership, commitment to the workplace, work engagement, job satisfaction, as well as stress and burnout. Thus, the Swedish version of PSC-4 can be regarded as a valid and reliable measure for both research and practical use for risk assessment at workplaces.

Not All Emotional Demands Are the Same: Emotional Demands from Clients' or Co-Workers' Relations Have Different Associations with Well-Being in Service Workers

There has been an increased interest in the study of emotional demands (ED) at work and its impact on workers’ well-being. However, ED have been conceptualized as a unitary concept, focused on interactions with clients, and excluding other potential sources of ED at work. Therefore, the aim of the current study is to explore the relation between ED from different relational sources (clients/patients/customers and colleagues, supervisors, and employees) and service workers’ exhaustion and engagement. Cross-sectional data from a sample of 2742 service workers were analysed using structural equation modelling. Results showed that ED from both sources (clients and colleagues) were associated with more emotional exhaustion, particularly if dealing with clients was not an integrated part of the role. Further, ED from clients’ relations were negatively associated with engagement for managers with staff responsibility, but positively for managers without staff responsibility. We also found moderating effects of psychosocial safety climate (PSC), whereby ED had the strongest effect on emotional exhaustion when PSC was low. This study suggests that different relational sources of ED at work have a different impact on employees’ well-being. Strategies that promote a reduction of extra-role ED, and the development of a PSC in the organization, could therefore offer possible solutions to promote employees’ psychological well-being and motivation.

Does staff-assessed care quality predict early failure of dental fillings? A prospective study

OBJECTIVES

The aim of this study was to evaluate staff-assessed care quality as an indicator of register-based measures of care quality at dental clinics, more specifically register-based measures of survival of dental fillings and initiation of preventive treatments for caries patients.

METHODS

This prospective study includes data from cross-sectional workplace psychosocial risk assessment surveys at dental clinics and register data on survival of dental fillings, and initiation of preventive treatment for caries patients obtained from the Swedish Quality Registry for Caries and Periodontal Disease (SKaPa) Demographic background data on the age, gender, income level and place of birth of patients was obtained from Statistics Sweden (SCB). The data were analysed using discrete-time multilevel survival analysis and multiple linear regression analysis.

RESULTS

The results showed that staff-assessed care quality rated by the total staff or by dental nurses at the clinic predicted the risk of replacement of dental fillings made due to a caries diagnosis during the 3-year follow-up period, controlling for potential confounding due to patient demographic characteristics (age, sex, income and country of birth). In contrast, the better the staff-assessed care quality at the clinic, the smaller the proportion of the patients received preventive care in addition to operative caries therapy when controlling for potential confounding due to patient demographics. Care quality assessed by dentists at the clinic did not predict either of these outcome measures.

CONCLUSIONS

Premature failure of dental fillings is costly for both patients and society, which leads to a need for relevant measures for following dental care quality. Our findings indicate that staff-assessed care quality - a cheap and easy measure to collect and follow continuously in dental practice - can be used to monitor aspects of quality in real time in order to facilitate continuous improvement and quickly amend quality problems. Also, it can be used for integrating quality improvement in systematic work environment risk management.

The Third Version of the Copenhagen Psychosocial Questionnaire

INTRODUCTION

A new third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) has been developed in response to trends in working life, theoretical concepts, and international experience. A key component of the COPSOQ III is a defined set of mandatory core items to be included in national short, middle, and long versions of the questionnaire. The aim of the present article is to present and test the reliability of the new international middle version of the COPSOQ III.

METHODS

The questionnaire was tested among 23,361 employees during 2016-2017 in Canada, Spain, France, Germany, Sweden, and Turkey. A total of 26 dimensions (measured through scales or single items) of the middle version and two from the long version were tested. Psychometric properties of the dimensions were assessed regarding reliability (Cronbach α), ceiling and floor effects (fractions with extreme answers), and distinctiveness (correlations with other dimensions).

RESULTS

Most international middle dimensions had satisfactory reliability in most countries, though some ceiling and floor effects were present. Dimensions with missing values were rare. Most dimensions had low to medium intercorrelations.

CONCLUSIONS

The COPSOQ III offers reliable and distinct measures of a wide range of psychosocial dimensions of modern working life in different countries; although a few measures could be improved. Future testing should focus on validation of the COPSOQ items and dimensions using both qualitative and quantitative approaches. Such investigations would enhance the basis for recommendations using the COPSOQ III.

Construct validity of a global scale for Workplace Social Capital based on COPSOQ III

Background and aim

Workplace Social Capital has been suggested as a useful concept when addressing organizational and social factors of the work environment. The overall aim of the present study is to establish and evaluate the construct validity of a measure of Workplace Social Capital based on the operationalization suggested in the third version of the Copenhagen Psychosocial questionnaire.

Methods

The present study is based on data collected as part of a validation and development project for the use of the Swedish version of COPSOQ at workplaces and includes responses from 1316 human service workers answering a workplace survey. Six items from scales for organizational justice, vertical trust and horizontal trust in COPSOQ III were included in the analyses. Rasch Analysis was used for scale validation.

Results

The analyses showed that the psychometric properties of the suggested COPSOQ scale for Workplace Social Capital were satisfactory after accommodation for local dependency. Each individual item worked as intended, the scale was unidimensional and functioned invariantly for women and men, and for younger and older employees. The scale was furthermore found to be valid for use for distinguishing groups, not individuals.

Conclusion

We have established that the scale for Workplace Social Capital measured by COPSOQ III is valid for distinguishing groups, e.g. work teams. The scale exhibits good construct validity as it satisfies the measurement criteria defined by the Rasch model.

No Job Demand Is an Island - Interaction Effects Between Emotional Demands and Other Types of Job Demands

Emotional demands are an inevitable feature of human services, and suggested to be a defining antecedent for workers’ stress and ill health. However, previous research indicate that emotional demands can have a favorably association to certain facets of human service workers’ motivation and well-being. Furthermore, recent research report that the effect of emotional demands on workers’ health and well-being seem to be contingent on the parallel level of other job demands. Still, initial investigations of interaction effects between emotional demands and other types of job demands have primarily focused on negative outcomes in terms of stress-related concerns and absenteeism. The present study investigated interaction effects between emotional demands and other types of job demands in relation to positive outcomes. In a larger sample of human service workers (social workers, n = 725), interaction effects were investigated between emotional demands and other job demands (quantitative demands, work pressure, and role conflict) for meaning in work and quality of work. Hypotheses stated that other job demands would moderate the relationship between emotional demands and positive outcomes, so that emotional demands would have a positive relation (i.e., act as a challenge) when the level of other demands is lower, but have a negative relation (i.e., act as a hindrance) when the level of other demands is high. Overall, the results provided support for the idea that emotional demands may act as a challenge. We found small but significant interaction effects between emotional demands and work pressure – in relation to meaning of work, as well as between emotional demands and quantitative demands, work pressure, and role-conflict, respectively – in relation to quality of work. Yet, the results did not support the assumption that emotional demands act as a hindrance when the level of other types of job demands is high. In sum, the results contribute by showing that emotional demands may promote human-service workers’ job attitudes when the level of parallel job demands is lower. We discuss the contribution of the study and the potential practical implications of the results, and give some suggestions for future research.

What happens to the physical and psychosocial work environment when activity-based offices are introduced into academia?

Purpose

There is an increased interest for introducing activity-based offices at universities. The purpose of this study is to contribute to the knowledge about the importance of the built environment for the psychosocial work environment within academia by analyzing how staff at a large Swedish university experienced the physical and psychosocial work environment before and after moving to activity-based offices.

Design/methodology/approach

A Web-based survey was distributed to all employees at two faculties at a university three months before (2015,n= 217, response rate 51 per cent) and nine months after (2016,n= 200, response rate 47 per cent) relocation to a new activity-based university building.

Findings

In the new premises, a vast majority (86 per cent) always occupied the same place when possible, and worked also more often from home. The social community at work had declined and social support from colleagues and supervisors was perceived to have decreased. The participants reported a lower job satisfaction after the relocation and were more likely to seek new jobs. No aspects in the physical or psychosocial work environment were found to have improved after the relocation.

Research/limitations implications

The study had a two-wave cross-sectional design, which does not allow establishing causal relations.

Practical implications

There is reason to be cautious about relocation to activity-based offices at universities. The potential savings in costs for premises may lead to may be followed by an increase in other costs. The risk that staff cannot concentrate on their work in activity-based university workplaces and lose their sense of community with colleagues are factors, which in the long run may lead to decreased efficiency, more conflicts and poorer well-being.

Originality/value

This paper contributes with new knowledge concerning changes in the physical and psychosocial work environment when relocating from cell offices to activity-based offices in a university setting.

Copenhagen Psychosocial Questionnaire - A validation study using the Job Demand-Resources model

Aim

This study aims at investigating the nomological validity of the Copenhagen Psychosocial Questionnaire (COPSOQ II) by using an extension of the Job Demands-Resources (JD-R) model with aspects of work ability as outcome.

Material and methods

The study design is cross-sectional. All staff working at public dental organizations in four regions of Sweden were invited to complete an electronic questionnaire (75% response rate, n = 1345). The questionnaire was based on COPSOQ II scales, the Utrecht Work Engagement scale, and the one-item Work Ability Score in combination with a proprietary item. The data was analysed by Structural Equation Modelling.

Results

This study contributed to the literature by showing that: A) The scale characteristics were satisfactory and the construct validity of COPSOQ instrument could be integrated in the JD-R framework; B) Job resources arising from leadership may be a driver of the two processes included in the JD-R model; and C) Both the health impairment and motivational processes were associated with WA, and the results suggested that leadership may impact WA, in particularly by securing task resources.

Conclusion

In conclusion, the nomological validity of COPSOQ was supported as the JD-R model-can be operationalized by the instrument. This may be helpful for transferral of complex survey results and work life theories to practitioners in the field.

It is not just about occupation, but also about where you work

OBJECTIVES

Dentistry is characterized by a meaningful but also stressful psychosocial working environment. Job satisfaction varies among staff working under different organizational forms. The aim of this study was to identify (i) to what extent crucial psychosocial work environment characteristics differ among occupations in general public dental clinics in Sweden, and (ii) how much of the variation within each occupation is attributable to the organizational level.

METHODS

All staff (N=1782) employed in four public dental organizations received an email with personal log-in to an electronic questionnaire based on the Copenhagen Psychosocial Questionnaire. After two reminders, a response rate of 75% was obtained. Responses from 880 nonmanagerial dentists, dental hygienists and dental nurses working in general practices were included in our analyses.

RESULTS

First, we compared the three dental occupations. We found that job demands, task resources (eg influence, possibilities for development and role clarity), strain symptoms and attitudes to work differed among occupations, dentists having the least favourable situation. Next, we compared the four organizations for each occupational group, separately. For dentists, a significant and relevant amount of variance (P<.05 and ICC >.05) was explained by the organizational level for 15 of 26 subscales, least pronounced for task resources. By contrast, for dental nurses and hygienists, the corresponding number was 2 subscales of 26. The psychosocial working environment of people working at the organization with the highest levels of strain indicators and the least positive work-related attitudes differed systematically from the organization with the most favourable profile, in particular regarding job demands and leadership aspects.

CONCLUSION

In conclusion, the psychosocial working environment depended to a large degree on occupation and, for dentists in particular, also on their organizational affiliation. The findings suggest a potential for designing interventions at organizational level for improvements of the psychosocial working environment for dentists.

Organization and overall job satisfaction among publicly employed, salaried dentists in Sweden and Denmark

BACKGROUND

In Sweden and Denmark, clinical dentistry is changing and public dentistry is in transition towards more market orientation. Dentists' overall job satisfaction is important for how public dentistry can fulfil the new expectations from patients, the public and politicians.

OBJECTIVES

The aim of this study was to investigate what organizational factors were important for publicly employed salaried dentists' overall job satisfaction.

METHODS

A random sample of active, general dental practitioners (private and publicly employed) was selected in Denmark and in Sweden, and they received a postal questionnaire. The number of questionnaires was 1835 and the response rate was 68% (n = 1226). This study analysed only the publicly employed dentists. The sampling frame for the Swedish dentists was 431, response rate 68.9% (n = 297) and for the Danish ones 194, response rate 81.9% (n = 159). Multivariate regression was used with overall job satisfaction as a dependent variable.

RESULTS

Common organizational variables were important. The used model explained between 32% (Sweden) and 39% (Denmark) of the variance in overall job satisfaction. The only significant individual factor was less job satisfaction for Swedish dentists born outside Sweden. An organizational climate characterized by a focus on professional values was associated with job satisfaction in both countries. Among the Swedish dentists, number of colleagues and degree of influence were also important and among the Danish ones sufficient time for patients.

CONCLUSIONS

Organizational factors had an impact on salaried publicly employed dentists' overall job satisfaction in both countries. The findings may have implications for other Human Service Organizations with employed professionals.

Collegial Support and Community with Trust in Swedish and Danish dentistry

OBJECTIVES

The aim of the study was to better understand the associations between work factors and professional support among dentists (Collegial Support) as well as the sense of being part of a work community characterized by trust (Community with Trust).

METHODS

A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models.

RESULTS

A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust.

CONCLUSION

A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists.

Measurement of social support, community and trust in dentistry

BACKGROUND AND AIM

Relationships among people at work have previously been found to contribute to the perception of having a good work. The aim of the present paper was to develop scales measuring aspects of social support, trust, and community among dentists, and to evaluate psychometric properties of the scales.

MATERIAL AND METHODS

In 2008, a questionnaire was sent to 1,835 general dental practitioners randomly selected from the dental associations in Sweden and Denmark. The response rate was 68% after two reminders. Principal Component Analysis was applied to 14 items and scales were established based on the resulting factors. Internal consistency was evaluated by Cronbach's alpha. Differential Item Functioning (DIF) with respect to gender, nationality and employment sector was analysed using ordinal logistic regression methods. Construct validity was assessed in relation to self-rated health and a range of work satisfaction outcomes.

RESULTS

The percentage of missing values on the items was low (range 0.7%-3.8%). Two scales (range 0-100) were established to measure 'Community with Trust'(nine items, mean = 79.2 [SD = 13.4], Cronbach's alpha = 0.89) and 'Collegial Support'(five items, mean = 70.4 [SD = 20.8], Cronbach's alpha = 0.89). DIF of only minor importance was found which supported cultural equivalence. The two scales were weakly positively correlated with each other. 'Community with Trust' was in general more strongly correlated with work satisfaction variables than 'Collegial Support' was.

CONCLUSIONS

Stability and internal consistency of the scales were considered as satisfactory. Content validity and construct validity were considered as good. Further validation in other populations is recommended.

Overall job satisfaction among dentists in Sweden and Denmark: A comparative study, measuring positive aspects of work

OBJECTIVE

Human service work differs from industrial work, which should be considered when organizing work. Previous research has shown organizational differences in the perceptions of work, often with a focus on negative aspects. The aim of this study was to analyse the overall job satisfaction among private- and public-practising dentists in Sweden and Denmark. This also implied a description of the questionnaire Swedish and Danish Dentists' Perceptions of Good Work about opportunities and positive and rewarding aspects of work.

MATERIAL AND METHODS

A questionnaire covering the multidimensional concept of good work was developed. A total of 1835 dentists randomly sampled from the dental associations were sent a questionnaire in November 2008. A special non-response study was performed. Principal components analysis (PCA) was used to create a measure of overall job satisfaction, comparing four organizational subgroups.

RESULTS

The average net response rate was 68% (n = 1226). The special non-response study of the Danish private practitioners showed more males, managers and dentists with more working hours than the respondents. PCA of three satisfaction questions showed a stable one-factor solution. There were differences in job satisfaction, with Danish public dentists ranked highest in overall job satisfaction and Swedish public dentists lowest.

CONCLUSIONS

There were organizational differences in the perception of job satisfaction. Further analysis of how the human service is organized in the different groups is needed.

Good Work for dentists - a qualitative analysis

OBJECTIVE

This study explores dentists' perceptions of Good Work in the meaning of positive and rewarding aspects in their work in contrast to a traditional problem-centred focus on work life.

METHODS

Nine informants were selected among Danish and Swedish general dental practitioners to obtain variation as to country of origin, gender, age and clinical work experience. Semi-structured, in-depth interviews were audio-recorded and transcribed verbatim in the original language. Statements concerning positive aspects of work were used for systematic text condensation according to the principles of Giorgi's phenomenological analysis, as modified by Malterud, generalizing descriptions reflecting aspects of Good Work. Selection of participants continued until saturation of the emerging categories was achieved.

RESULTS

The core of Good Work emanates from the clinical encounter: from the relation with the patient and from the opportunity to carry out high quality odontological handicraft. Social relations at the workplace, as well as organizational values and conditions were perceived as influencing the opportunities to achieve the rewarding aspects from the clinical encounter.

CONCLUSIONS

The results implicate a need for developing a work-environmental model with intrinsic as well as extrinsic rewards when dealing with human service organizations. At policy level it is necessary to address the professional culture.

Perceived social support in relation to work among Danish general dental practitioners in private practices

Social support is an important phenomenon in the psychosocial work environment. The aim of this study was to assess the extent to which Danish general dental practitioners perceived support from colleagues and to relate perceived support to demographic and work related background factors. A questionnaire was sent to a random sample of 300 Danish dentists. The response rate was 80% after one reminder. Factor analyses and multiple regression analyses were carried out. The results showed that clinic size was the overall most important variable explaining perceived support among dentists. Gender differences were found in perceived emotional and practical support, and women perceived more emotional support (e.g. discussing problematic patients with peers) than their male colleagues. A similar gender difference was not found for the perception of practical support, such as helping each other in the event of falling behind schedule. Dentists from small and large practices did not differ in the extent of peer contact outside the clinical environment. This study emphasized the importance of the organizational setting for a professional and personal supportive psychosocial working environment in dentistry.

The effect of environmental enrichment on the behaviour of caged rabbits (Oryctolagus cuniculus)

Behaviour and use of the cage area were studied in 96 rabbits (Oryctolagus cuniculus) kept in an enriched cage system - with access to shelter and raised height at the back of the cage - and in a conventional cage system to estimate the effects of the environmental enrichment on the rabbits' welfare. The rabbits' behaviour and placement in the cage were observed, using continuous video recording through 24 h and direct scan sampling during the daytime. In addition, an open-field test was carried out with each rabbit, and after every single test, the rabbits' timidity of being captured was recorded. Rabbits kept in the conventional cage system, especially the females, showed more restlessness, excessive grooming, bar-gnawing and timidity than rabbits kept in the enriched cage system. This indicates increased stress in the rabbits kept in the conventional cage system. All the rabbits performed most of the active behavioural elements in the daytime and were resting mostly at night that shows that the rabbits in both cage systems were adapted to the daily activity in the animal unit; the enrichment had no effect on the daytime activity.Only a few rabbits, particularly the females, used the box as a shelter or resting-place. On the other hand, they more often used the roof of the box as a look-out or resting-place. Furthermore, the rabbits' behaviour showed that they utilised the raised height in the enriched cage system.These results indicate that rabbits kept in an enriched cage system, particularly the females, had better welfare than rabbits kept in a conventional cage system because they had access to shelter and a better chance of interacting with the environment.