The significance of the psychosocial work environment for care workers`perceived health, presenteeism, rationing of care, and job satisfaction: a sub-study of the Swiss Nursing Home Human Resources Project (SHURP)

Healthcare is a high-risk industry, not only for patients, but also for staff, whose health and wellbeing can be affected. While research has extensively examined the health of care workers in hospital settings, nursing homes have been less researched in this regard. Nursing homes are an important sector of the care system that is becoming increasingly complex with the growing elderly population. In Switzerland, with the introduction of Diagnostic Related Group (DRG) with reduced length of hospital stay and accelerated patient discharge, nursing homes are delivering more sub-acute care to residents with complex medical conditions. More than half of residents in Swiss nursing homes are diagnosed with dementia or show signs of dementia, and require assistance to meet basic needs in activities of daily living. Consequently, nursing home care workers often perform nursing activities such as patient handling and positioning, and communicating with challenging residents that put them at risk of physical injuries and compromised mental health. A particular concern is presenteeism, which refers to attending to work while ill, and which showed to be common among care workers. Workplace environments in health care settings have shown to be with risks for staff health, e.g. for musculoskeletal injuries and needle stick injuries. Researchers also found increased rates of emotional exhaustion and musculoskeletal pain among direct care providers. Job demands at work were found strong factors in contributing to increased injury rates. Mental health outcomes were positively influenced by social support at work. While the magnitude of the problem of care workers working through illness and its ramification on the provision of care in nursing homes has not been fully identified so far, researchers recognize its effect on the quality of care. This dissertation aims to explore care workers` reported physical and mental health in Swiss nursing homes, analysed relationships with contributing factors (e.g. psychosocial work environment factors) and outcomes (e.g. rationing of residents care and job satisfaction) in four studies. These studies analyse data from the Swiss Nursing Homes Human Resource Project (SHURP), including survey responses from a survey of 5,323 care workers in 162 Swiss nursing homes, across the three language speaking regions (German, French, and Italian). The dissertation is organized in six chapters: Chapter 1 is an overall literature-based introduction to the topic. It explores the association of the work environment and care worker’s health. Emphasis is placed on nursing home care workers, and the importance of their perception of work environment factors, including, but not limited to, leadership, staffing adequacy, work stressors, and autonomy at work, and how they influence care workers related behaviour (e.g. presenteeism, absenteeism). The influence of care workers` health on rationing of care, and the relationship between health and work environment with care workers` job satisfaction, are also discussed. An overview of the state of research on care workers` health in nursing homes and the conceptual framework of this dissertation is presented. In the final part of the introduction, gaps in the literature are summarized, along with the contribution of this dissertation to address those gaps. Aims and rationale of the dissertation are described. Findings addressed in four component studies are reported (Chapter 2 to Chapter 5). Chapter 2 reports on our study describing care workers` perceived health, exploring relationships between selected perceived work environment factors and self-reported physical and mental health outcomes. In this sample of 3,471 care workers from 155 nursing homes across Switzerland, 38% reported at least one compromised physical health outcome, and 27.4% reported at least one mental health outcome. Back pain (19.0 %, n=655), and joint pain (13.5%, n=464) were reported physical health outcomes. Emotional exhaustion (24.2%, n=834), tiredness (14.4%, n=494), sleeplessness (12.6%, n=432) were the most prevalent self-reported mental health outcomes. After controlling for major organizational variables and care workers` characteristics, percentage of residents with dementia, physical violence and participation in decision-making were not predictors of health outcomes in our regression models. However, back pain and joint pain were associated with increased workload, conflict with other professionals and lack of recognition, frequent verbal aggression by residents, and perceived poor staffing adequacy. Sleeplessness, tiredness, headache, and emotional exhaustion from work, were associated with stress related to increased workload and conflict with other professionals and lack of recognition. Perceptions of strong leadership were associated with low-reported emotional exhaustion. Overall, our findings confirmed that poor psychosocial work environmental factors in nursing homes were related to the perceived physical and mental health of care workers. Modifying psychosocial work environment factors in Swiss nursing homes is a promising strategy to improve the health of their staff. Chapter 3 presents the results of our explorative study of the prevalence of presenteeism and absenteeism in Swiss nursing homes, and their associations with care worker-reported selected psychosocial work environment factors. Of the studied 3,176 care workers in 162 nursing homes, prevalence of presenteeism (32.9%) was higher than absenteeism (14.6%). Although self-reported absenteeism showed no significant association with any of the psychosocial work environment factors investigated in this study, low reported presenteeism was associated with perceptions of supportive leadership (OR 1.22, CI 1.01-1.48), and adequate staffing resources (OR 1.18, CI 1.02-1.38) only. The findings suggest that presenteeism is an area that has been overlooked in nursing homes. Hence, it is reasonable to focus on presenteeism in order to promote care workers` health and to promote productivity and sustain the organization. Future analysis is needed to investigate the influence of presenteeism on the provision of residents care. Chapter 4 presents study findings on the association between care workers-reported health, presenteeism and perceived implicit rationing of care. Studies showed that the exposure to an unhealthy workplace can compromise care workers physical and mental health. As the WHO Model for Healthy Workplace suggests, ill employees who work through illness have reduced work performance. Work performance can be assessed through omission rates in relation to required tasks. Care providers often reported implicit rationing of care (i.e. omission of care) due to various limitations. Of the 3,239 participating care workers in 162 nursing homes, physical and mental health issues, and presenteeism were of concern, and rationing of care was reported as rare. Our findings give support to the sensitivity of rationing of care to health issues: For rationing of activities of daily living, our regression model showed a positive association with perceived health: joint pain (β 0.04, CI 0.001-0.07), emotional exhaustion (β 0.11, CI 0.07-0.15), and presenteeism (β 0.05, CI 0.004-0.09). For rationing of caring, rehabilitation, and monitoring, results were similar: joint pain (β 0.05, CI 0.01-0.09), and emotional exhaustion (β 0.2, CI 1.16-0.24). Health organizations should be aware of health-related issues at the workplace to promote and maintain care workers` health, in order to ensure resident safety and appropriate provision of care. Further observational studies are needed to gain a deeper understanding of the individual decision of care workers for presenteeism and its’ impact on work performance, which may ultimately impact quality of care. Chapter 5 presents major findings on care workers` job satisfaction and its association with work environment factors and perceived health. Recruiting and retaining care workers to meet the challenges of a growing elder population are connected to the satisfaction of care workers in the workplace. The conceptual analysis of job satisfaction showed that this affective response behaviour is not only linked to personal characteristics but also to one`s desired and expected outcomes. Hence, this study investigated the influence of work environmental aspects and perceived health on 4,145 care workers in 162 Swiss nursing homes. Results showed that high job satisfaction was associated with perceived supportive leadership (OR 3.76; CI 2.83-5.00), enhanced teamwork and resident safety climate (OR 2.60; CI 2.01-3.33), the availability of nursing home director (OR 2.30; CI 1.67-2.97), and staffing adequacy (OR 1.40; CI 1.15-1.70). However, it was reduced in the presence of workplace conflict (OR 0.61; CI .49-.76), compromised physical health (OR 0.91; CI 0.87-0.97), and emotional strain (OR 0.88; CI 0.83-0.93). To retain care workers and recruit new ones, nursing homes should modify substantial work environment (e.g. leadership and staffing adequacy) aspects in order to promote job satisfaction among their staff. Future longitudinal research is needed to confirm the observations made in this cross-sectional study design. Finally, in Chapter 6 major findings of the individual studies are synthesized and discussed, substantive theoretical findings are stressed, and methodological strengths and limitations of this dissertation are presented. Moreover, implications for further research and clinical practice are recommended. The findings of this dissertation add to the existing literature the first evidence regarding the impact of health and presenteeism on rationing of care. Our findings confirm the underlying theoretical assumption that safer work environment is a protective aspect of care workers` health and wellbeing. Although these findings suggest the need to improve work environment and care workers` health in Swiss nursing homes to ensure better provision of resident care, it remains unclear whether improving care workers` health will lead to improved quality of care. This dissertation will contribute to the further development of healthy workplaces and their relationship to job performance and quality of care, and raises methodological issues that will require considerations in future studies

A multi-level perspective on perceived unmet needs for home support in home-dwelling older adults in the Swiss context: a secondary data analysis of a population study

Unmet needs for home support occur when any support services perceived by older people as needed are not being received. Not meeting these needs can negatively impact older adults' quality of life, and increase health care utilization, hospitalizations, institutionalizations, or death. To date there is no consensus in how to define and assess these unmet needs. In parallel, previous research of factors associated with unmet needs for home support has mostly focused on factors at the micro level. Thus, this paper aims to identify the prevalence of unmet needs for home support among a home-dwelling older population and the factors at the macro, meso and micro levels contributing to them.; Using an ecological approach we identified multi-level factors associated with the presence of unmet needs for home support among the home-dwelling older population (aged 75+) in Switzerland. This is a secondary cross-sectional analysis of the INSPIRE Population Survey of home-dwelling older adults (n = 8,508) living in Basel-Landschaft in Switzerland, conducted as part of the TRANS-SENIOR Project. Prevalence of perceived unmet needs for home support was self-reported, using a dichotomized question. Multiple logistic regression analyses were performed to investigate the associations of factors at each level with unmet needs for home support.; 4.3% of participants reported unmet needs for home support, with a median age of 81 years. 45.1% had private health insurance and 6.3% needed additional government support. Being a recipient of other type of government support (OR = 1.65; 95% CI = 1.17-2.29) (macro-); the use of transportation services (OR = 1.74; 95% CI = 1.15-2.57) (meso-); and feeling depressed (OR = 1.40; 95% CI = 1.06-1.85) or abandoned (OR = 2.60; 95% CI = 1.96-3.43) (micro-) increased odds of having perceived unmet needs for home support. Having a private health insurance (macro-) (OR = 0.63; 95% CI = 0.49-0.80), speaking Swiss-German (OR = 0.44; 95% CI = 0.24-0.88) or German (OR = 0.47; 95% CI = 0.24-0.98), having a high level of education [primary (OR = 0.48; 95% CI = 0.24-1.02); secondary (OR = 0.49; 95% CI = 0.25-1.03); tertiary (OR = 0.38; 95% CI = 0.19-0.82); other (OR = 0.31 (0.12-0.75)], having a high score of self-perceived health status [score ≥ 76 (OR = 0.42; 95% CI = 0.20-0.96)] and having informal care (OR = 0.57; 95% CI = 0.45-0.73), among others (micro-) were associated with decreased odds of having perceived unmet needs for home support.; Our study findings highlight the role of socio-economical inequality in the perception of unmet needs for home support in home-dwelling older adults. In order to address unmet needs in home-dwelling older adults, healthcare leaders and policy makers should focus on strategies to reduce socio-economic inequalities at the different levels in this population

Trends and variability of implicit rationing of care across time and shifts in an acute care hospital : a longitudinal study

The proposed study was funded for 2 years (2018‐2020) by the Medical Practice Plan, Faculty of Medicine, American University of Beirut, Lebanon.Background Implicit rationing of nursing care is associated with work environment factors. Yet a deeper understanding of trends and variability is needed. Aims To explore the trends and variability of rationing of care per shift between individual nurses, services over time, and its relationship with work environment factors. Methods Longitudinal study including 1,329 responses from 90 nurses. Intraclass correlation coefficients (ICC) were computed to examine variability of rationing per shift between individual nurses, services, and data collection time; generalized linear mixed models were used to explore the relationship with work environment factors. Results Percentage of rationing of nursing activities exceeded 10% during day and night shifts. Significant variability in rationing items was observed between nurses, with ICCs ranging between 0.20 and 0.59 in day shifts, and between 0.35 and 0.85 in night shifts. Rationing of care was positively associated with nurses’ self‐perceived workload in both shifts, but not with patient‐to‐nurse ratios. Conclusion Most variability in rationing over time was explained by the individual.PostprintPeer reviewe

Protocol for a mixed methods feasibility and implementation study of a community-based integrated care model for home-dwelling older adults: The INSPIRE project

Evaluations of integrated care models for home-dwelling frail older adults have shown inconclusive results on health and service outcomes. However, limited research has focused on the implementation of integrated care models. Applying implementation science methods may facilitate uptake of integrated care models, thus generating positive outcomes e.g., reduced hospital admissions. This paper describes the protocol to assess the feasibility of an integrated care model (featuring a four-step comprehensive geriatric assessment: screening, a multi-dimensional assessment, a coordinated individualized care plan and follow-up) designed for a new community-based center for home-dwelling older adults in Switzerland. The study includes the following objectives: 1) to assess implementation by a) monitoring respondents to the outreach strategies and describing the Center's visitors; b) assessing implementation outcomes related to the care model (i.e., adoption, acceptability, feasibility, fidelity) and implementation processes related to collaboration; and 2) assessing implementation costs.; For objective 1a, we will use a descriptive design to assess respondents to the outreach strategies and describe the Center's visitors. We will use a parallel convergent mixed methods design for objective 1b. Implementation outcomes data will be collected from meetings with the Center's staff, interviews with older adults and their informal caregivers, and reviewing older adults' health records at the Center. Implementation processes related to collaboration will be assessed through a questionnaire to external collaborators (e.g., GPs) towards the end of the study. For objective 2, implementation costs will be calculated using time-driven activity-based costing methods. Data collection is anticipated to occur over approximately six months.; This study of a contextually adapted integrated care model will inform adaptations to the outreach strategies, care model and implementation strategies in one community center, prior to evaluating the care model effectiveness and potentially scaling out the intervention.; Feasibility study registration ID with clinicaltrials.gov: NCT05302310; registration ID with BMC: ISRCTN12324618

Factors associated with health-related quality of life among home-dwelling older adults aged 75 or older in Switzerland: a cross-sectional study

HRQoL is an indicator of individuals' perception of their overall health, including social and environmental aspects. As a multidimensional concept, HRQoL can be influenced by a multitude of factors. Studies of HRQoL and factors associated with it among home-dwelling older adults have often been limited to inpatient settings or to a sub-population with a chronic disease. Studying HRQoL and its correlating factors among this population, by providing an ecological lens on factors beyond the individual level, can provide a better understanding of the construct and the role of the environment on how they perceive their HRQoL. Thus, we aimed to assess the HRQoL and investigate the correlates of HRQOL among home-dwelling older adults, guided by the levels of the ecological model.; This is a cross-sectional population survey conducted in 2019 in Canton Basel-Landschaft, in northwestern Switzerland, and includes a sample of 8786 home-dwelling older adults aged 75 and above. We assessed HRQoL by using the EQ-index and the EQ-VAS. The influence of independent variables at the macro, meso and micro level on HRQoL was tested using Tobit multiple linear regression modelling.; We found that having a better socio-economic status as denoted by higher income, having supplementary insurance and a higher level of education were all associated with a better HRQoL among home-dwelling older adults. Furthermore, being engaged in social activities was also related to an improved HRQoL. On the other hand, older age, female gender, presence of multimorbidity and polypharmacy as well as social isolation and loneliness were found to all have a negative impact on HRQoL.; Understanding factors related to HRQoL by using an ecological lens can help identify factors beyond the individual level that impact the HRQoL of home-dwelling older adults. Our study emphasises the importance of social determinants of health and potential disparities that exists, encouraging policymakers to focus on policies to reduce socio-economic disparities using a life-course approach, which consequently could also impact HRQoL in later stages of life

How to conceptualize and implement a PhD program in health sciences - the Basel approach

Over the past decade, several excellent guidelines have been published on how to enhance the quality of PhD education in Europe. Aimed primarily at preparing students for innovative roles in their fields, they include variously structured approaches to curricular offerings, as well as other program components applicable across specialties (eg: supervisor support, scientific conduct, transferable skills). Since 2012, the interdisciplinary PhD Program in Health Sciences (PPHS) at the Faculty of Medicine of the University of Basel in Switzerland has focused on translating these guidelines into a 21st-century health sciences PhD program.; The PPHS started in 2012 based on the European Union (EU) guidelines for PhD education. This article describes the resulting interdisciplinary PhD program's conceptual underpinnings, rationale, structures, and 10 building blocks, like student portfolios, thematic training, interdisciplinary research seminars, student-initiated interdisciplinary activities, financial support of course participation, top-up and extension stipends, PhD supervision, research integrity, alumni follow-up network, and promotional tools including a dedicated website. Students enter from Clinical Research, Medicine Development, Nursing Science, Epidemiology and Public Health including Insurance Medicine, Sport Science (all from the Faculty of Medicine), and Epidemiology (Faculty of Science).; The Basel PPHS exemplifies state-of-the-art PhD education in Health Sciences based on European guidelines and offers guidance to other groups from conceptualization to rollout of an interdisciplinary health sciences PhD program

Health and social care of home-dwelling frail older adults in Switzerland : a mixed methods study

Home-dwelling frail older adults are often faced with multimorbidity and complex care needs, requiring health and social care systems that support frail older adults to age in place. The objective of this paper was to investigate the types of formal health and social care as well as informal care and social support used by home-dwelling frail older adults; whether they perceive their support as sufficient; and their experience with and preferences for care and support

The occurrence, types, consequences and preventability of in-hospital adverse events – a scoping review

Abstract Background Adverse events (AEs) seriously affect patient safety and quality of care, and remain a pressing global issue. This study had three objectives: (1) to describe the proportions of patients affected by in-hospital AEs; (2) to explore the types and consequences of observed AEs; and (3) to estimate the preventability of in-hospital AEs. Methods We applied a scoping review method and concluded a comprehensive literature search in PubMed and CINAHL in May 2017 and in February 2018. Our target was retrospective medical record review studies applying the Harvard method–or similar methods using screening criteria–conducted in acute care hospital settings on adult patients (≥18 years). Results We included a total of 25 studies conducted in 27 countries across six continents. Overall, a median of 10% patients were affected by at least one AE (range: 2.9–21.9%), with a median of 7.3% (range: 0.6–30%) of AEs being fatal. Between 34.3 and 83% of AEs were considered preventable (median: 51.2%). The three most common types of AEs reported in the included studies were operative/surgical related, medication or drug/fluid related, and healthcare-associated infections. Conclusions Evidence regarding the occurrence of AEs confirms earlier estimates that a tenth of inpatient stays include adverse events, half of which are preventable. However, the incidence of in-hospital AEs varied considerably across studies, indicating methodological and contextual variations regarding this type of retrospective chart review across health care systems. For the future, automated methods for identifying AE using electronic health records have the potential to overcome various methodological issues and biases related to retrospective medical record review studies and to provide accurate data on their occurrence

Factors associated with high job satisfaction among care workers in Swiss nursing homes - a cross sectional survey study

BACKGROUND: While the relationship between nurses' job satisfaction and their work in hospital environments is well known, it remains unclear, which factors are most influential in the nursing home setting. The purpose of this study was to describe job satisfaction among care workers in Swiss nursing homes and to examine its associations with work environment factors, work stressors, and health issues. METHODS: This cross-sectional study used data from a representative national sample of 162 Swiss nursing homes including 4,145 care workers from all educational levels (registered nurses, licensed practical nurses, nursing assistants and aides). Care worker-reported job satisfaction was measured with a single item. Explanatory variables were assessed with established scales, as e.g. the Practice Environment Scale - Nursing Work Index. Generalized Estimating Equation (GEE) models were used to examine factors related to job satisfaction. RESULTS: Overall, 36.2 % of respondents reported high satisfaction with their workplace, while another 50.4 % were rather satisfied. Factors significantly associated with high job satisfaction were supportive leadership (OR = 3.76), better teamwork and resident safety climate (OR = 2.60), a resonant nursing home administrator (OR = 2.30), adequate staffing resources (OR = 1.40), fewer workplace conflicts (OR = .61), less sense of depletion after work (OR = .88), and fewer physical health problems (OR = .91). CONCLUSIONS: The quality of nursing home leadership-at both the unit supervisor and the executive administrator level-was strongly associated with care workers' job satisfaction. Therefore, recruitment strategies addressing specific profiles for nursing home leaders are needed, followed by ongoing leadership training. Future studies should examine the effects of interventions designed to improve nursing home leadership and work environments on outcomes both for care staff and for residents