Work experiences among healthcare professionals in the beginning of their professional careers : a gender perspective

Swedish healthcare organizations have undergone substantial organizational and economic restructuring during the 1990s due to financial cutbacks. Little is known about recently graduated healthcare professionals´ work experience in healthcare and their future career preferences. The overall aims of this thesis was, to increase knowledge about how recently graduated healthcare professionals in Sweden perceive their work in healthcare organizations. A gender perspective is adopted. In this national cross-sectional study, four stratified random samples were separately drawn from the 1999 Swedish university graduates who were nurses (NS), occupational therapists (OT), physical therapists (PT) and (registered) physicians (PN) and who at the time of the sampling procedure were living in Sweden. Stratification was performed by sex. A total of 3989 were eligible and of those, 1434 were selected: 535 NS, 250 OT, 250 PT and 399 PN. A questionnaire was constructed containing questions about socio-demographic factors, working conditions, career preferences,  work satisfaction and questions about the responsibility for and actual work with home and family, the so called unpaid household work. The questionnaires also contained questions measuring psychosocial working conditions: the effort-reward imbalance questionnaire (ERI-Q) and the demand-control questionnaire (DCQ). Collection of the data for NS, OT and PT was completed in March 2002 and for PN in May 2003. The response rate was 81% and 76% respectively. The total sample thus consists of 1145 participants; 423 nurses, 212 occupational therapists, 205 physiotherapists and 305 physicians.  Most of the respondents were employed in the public sector, but many desired privately employment within the coming five year period, men more often than women. Career preferences for future work differed between women and men. A majority indicated that they did not have the opportunity to pursue knowledge development in the professional field during working hours and nearly one half could not work as independently as they wished. Satisfaction with work in general was high, but many were dissatisfied with management at work and a majority was dissatisfied with the work organization. This dissatisfaction was associated with the opportunity to work as independently as they wished and the opportunity to pursue knowledge development in the professional field. Significantly more women than men had the main responsibility for home and family and did most of the unpaid household work. Among the OT and PT working for county councils and municipalities, the results revealed that those working for municipalities, experienced low control at work compared with those working for county councils. No differences were found between OT and PT or between men and women in the two professions regarding the DCQ and the ERI-Q except for the WOC scale. Women had significantly higher scores on the WOC scale compared with men. Logistic regression analyses revealed a significant association between WOC and ERI, effort, reward and sex. One fourth of the OT and PT working for county councils and municipalities was dissatisfied with their job and this dissatisfaction was significantly associated with type of employer, reward and effort-reward imbalance (in the ERI-Q) and control (in the DCQ). Differences regarding scoring on the ERI-Q were found between nurses and physicians working in county councils but not between women and men in the same group, with the exception of the scores on overcommitment. Significantly more nurses were defined as having high effort, low reward and effort-reward imbalance compared with the physicians. More women in the NS and PN group were defined as experiencing WOC compared to men.  Logistic regression analyses revealed significant associations between experiences of WOC and ERI, effort and reward. Nearly one fifth in the NS and PN group were dissatisfied with work and this dissatisfaction was particularly high among those with high effort, low reward, those with the greatest imbalance between effort and reward and those who experienced high overcommitment. In conclusion, in order to limit future work related problems and to be able to retain well educated professionals in healthcare work, dissatisfaction among the recently graduated must be taken seriously. Healthcare employers should better utilize the knowledge that recently graduated possess, regarding for example how to be a part of the development of the profession and the job. It is also important that healthcare employers address gender (in) equality at work and that work environments allow both women and men to combine careers with family duties.healthcare, work satisfaction, career, gender equality, health science education, recently graduated, novices, nurses, occupational therapists, physiotherapists, physicians, ERI-Q, effort, reward, effort-reward imbalance, overcommitment, DCQ, demand, control, job strai

Choreographing life-experiences of balance control in people with Parkinson’s disease

CITATION: LaGrone, S., et al. 2020. Choreographing life-experiences of balance control in people with Parkinson’s disease. BMC Neurology, 20:50, doi:10.1186/s12883-020-01632-4.The original publication is available at https://bmcneurol.biomedcentral.comBackground: Parkinson’s disease (PD) is a devastating neurodegenerative disorder. Reduced balance is one of the cardinal symptoms of PD, predisposing people living with PD to experience difficulties with the execution of tasks and activities, as well as hindering their involvement in meaningful life areas. The overarching aim of this study was to explore how deficits in balance control manifest in everyday life and how it is managed by people with PD (PwPD). Methods: Qualitative description was used as methodology, and in-depth interviews were conducted with 18 participants, between the ages of 46 to 83 years, with mild to severe PD. Interview transcripts were analyzed using qualitative content analysis, following an inductive approach. Results: One theme emerged from the analysis: Increased planning—choreographing life. Within this overarching theme, two categories were identified, namely Limitations in mobility and New restricted functioning in everyday life, each with 3–4 sub-categories. The categories described how PwPD handled decreased balance control in their everyday life by using motor and cognitive strategies as a consequence of not trusting their body’s capacity to control balance. Activities in everyday life, as well as the ability to partake in leisure and social activities were profoundly affected. Conclusion: People with mild to severe PD used strategies to handle decreased balance and they choreographed their lives around their individual current state of mobility and balance. The knowledge gained from this study can be used to develop targeted interventions addressing the nuances of balance deficits in everyday life.https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-020-01632-4Publisher's versio

Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives

Background: Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services. Objectives: To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective. Methods: A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS). Results: In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028). Conclusion: Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions

What is a good workplace? : Tracing the logics of NPM among managers and professionals in Swedish elderly care

Neoliberal policies such as new public management (NPM) have been pivotal to the Swedish elderly care system for two decades. This article explores the discourses of NPM and work by focusing on how a good workplace is represented by professionals and managers in Swedish elderly care. Using qualitative interviews with 31 managers, nurses, physiotherapists, and occupational therapists at nine workplaces, we identified four competing meanings (“storylines”) of how a good workplace is constructed among the interviewees within an ongoing struggle between two discourses. Three storylines, i.e., striving to achieve the mission, a desire to work in elderly care, and striving for good working relationships, are linked to the neoliberal discourse of organizational effectiveness. In contrast, the fourth storyline, support and better working conditions, is related to a welfare-state discourse of traditional labor relations with strong historical roots. Four subject positions available to the managers and professionals were identified: the bureaucrat, the passionate, the professional, and the critic. We conclude that NPM is translated on top of existing discourses, such as those of traditional labor relations, care ideals, and practices, that are already established in elderly care workplaces and that counteract the new policy.Special issueHur ska äldrevården bli mer attraktiv och kunna rekrytera kompetent personal I en tid av ökande antal äldre i befolkningen? En genusanaly

Team social cohesion, professionalism, and patient-centeredness : gendered care work, with special reference to elderly care – a mixed methods study

Background: Healthcare organisations are facing large demands in recruiting employees with adequate competency to care for the increasing numbers of elderly. High degrees of turnover and dissatisfaction with working conditions are common. The gendered notion of care work as 'women's work', in combination with low salaries and status, may contribute to negative work experiences. There is abundant information about the negative aspects of elderly care health services, but little is known about positive aspects of this work. The study aim was to investigate work satisfaction from a gender perspective among Swedish registered nurses, physiotherapists, and occupational therapists, focusing specifically on healthcare services for the elderly. Methods: A mixed methods approach was adopted in which we combined statistics and open-ended responses from a national survey with qualitative research interviews with healthcare professionals in elderly care organisations. The survey was administered to a random sample of 1578 registered nurses, physiotherapists, and occupational therapists. Qualitative interviews with 17 professionals were conducted in six elderly care facilities. Qualitative and quantitative content analyses, chi2 and constructivist grounded theory were used to analyse the data. Results: There was a statistically significant difference in overall work satisfaction between those who worked in elderly care and those who did not (64 and 74,4% respectively, p &lt; 0.001). Nine themes were derived from open-ended responses in the questionnaire. The qualitative interviews revealed four prominent storylines: 'Team social cohesion', 'Career development and autonomy', 'Client-centeredness', and 'Invisible and ignored power structures'. Conclusions: The results show the complexity of elderly care work and describe several aspects that are important for work satisfaction among health professionals. The results reveal that work satisfaction is dependent on social interrelations and cohesion in the work team, in possibilities to use humour and to have fun together, and in the ability to work as professionals to provide client-centered elderly care. Power relations such as gendered hierarchies were less visible or even ignored aspects of work satisfaction. The storylines are clearly linked to the two central discourses of professionalism and gender equality

What is a good workplace? : Tracing the logics of NPM among managers and professionals in Swedish elderly care

Neoliberal policies such as new public management (NPM) have been pivotal to the Swedish elderly care system for two decades. This article explores the discourses of NPM and work by focusing on how a good workplace is represented by professionals and managers in Swedish elderly care. Using qualitative interviews with 31 managers, nurses, physiotherapists, and occupational therapists at nine workplaces, we identified four competing meanings (“storylines”) of how a good workplace is constructed among the interviewees within an ongoing struggle between two discourses. Three storylines, i.e., striving to achieve the mission, a desire to work in elderly care, and striving for good working relationships, are linked to the neoliberal discourse of organizational effectiveness. In contrast, the fourth storyline, support and better working conditions, is related to a welfare-state discourse of traditional labor relations with strong historical roots. Four subject positions available to the managers and professionals were identified: the bureaucrat, the passionate, the professional, and the critic. We conclude that NPM is translated on top of existing discourses, such as those of traditional labor relations, care ideals, and practices, that are already established in elderly care workplaces and that counteract the new policy.Special issueHur ska äldrevården bli mer attraktiv och kunna rekrytera kompetent personal I en tid av ökande antal äldre i befolkningen? En genusanaly

Professional knowledge development and evidence-based practice in confusing vs. supportive work organizations : A grounded theory situational analysis of Swedish elderly care

Background: This article focuses on knowledge development and health professionals’ opportunitiesto use evidence-based practice (EBP). We studied registered physiotherapists (PT), occupationaltherapists (OT) and nurses (RN) in Swedish elderly-care institutions, a sector known for highturnover and shortages of competent staff.Objective: To examine the perspectives of healthcare providers on professional knowledge developmentand EBP in their organization. Methods: We conducted on-site qualitative interviews with a purposive sample of PTs, OTs andRNs, in six elderly care institutions. Situational analysis was used to analyze the material. Results: Three discursive professional positions were found: 1) Professional ambition in confusingwork organization; 2) Professional ambition in a knowledge-promoting work organization; and 3) Professional indifference with few aspirations for knowledge development. Professional aspirationstoward knowledge development were high in two of these positions, whereas the third representsa slightly different approach with fewer aspirations for knowledge development. Linked to theseprofessional approaches to knowledge development is a continuum of aggravating or facilitatingfactors within the work organization, including varying degrees of support from leadership of theorganization, as well as few opportunities for rewards. Discussion and conclusions: It is concluded that elderly care needs to develop strategies forevidence-based practice in order for the sector to become a sustainable arena for health professionals’career development, and in order to improve the quality of care for the elderly

Unequal physical activity among children with cerebral palsy in Sweden : A national registry study

Aim: To examine the extent to which sex, country of birth, and functional aspects influence participation in physical education and physical leisure activity among children with cerebral palsy (CP) in Sweden. Methods: This national cross-sectional registry study included children with CP aged 6 to 18 years who participated in the Swedish national quality registry, the Cerebral Palsy Follow-up Program, CPUP, in 2015. Comparisons and associations between sex, country of birth, and functional aspects and physical leisure/physical education were examined using chi-squared and multivariable logistic regression analysis. Results: The study included 1935 children. Of them, 1625 (87%) reported participating in physical education and 989 (53%) reported participating in physical leisure activity. Children born in Sweden had higher odds of participating in physical education (OR: 1.99; 95% CI: 1.20-3.28) and physical leisure activity (OR: 2.51; 95% CI: 1.70-3.72) compared with children born outside Europe. Greater impairment of gross motor function was associated with lower participation levels. Boys participated slightly more frequently in leisure activities than girls. Conclusion: Enhancing social inclusion with regard to disability, birth country, and sex are important and achievable goals for policymakers and practitioners for promoting participation in physical activity for children and adolescents with CP

Gender matters in physiotherapy

The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy