Workplace development and learning in elder care – the importance of a fertile soil and the trouble of project implementation

Workplace learning and competence development in work are frequently used concepts. A wide spread notion is that societal, institutional, and organizational changes require the development of knowledge, methods and strategies for learning at workplaces, in both public and private enterprises. In research on learning and competence development at work, the organizational learning and development as well as individual accomplishments are investigated from various perspectives and in different contexts. The theoretical base for research projects can, accordingly, be focused at a number of organizational and system levels. This paper describes a research project called "Workplace development and learning in elder care" in which learning and knowledge were key issues and where Activity Theory was used as the theoretical base. The project was joint project between two research and development field units. These were UFFE, a municipal social services’ field research unit, and Äldrecentrum Västerbotten, a county council field research unit which aims to serve the interests of the elderly. The project was launched in the fall of 2000 and ended in the summer of 2003. I was employed part-time as a research leader at the municipal research unit and became the research leader for this particular project. A number of students, as well as employees from the county council geriatric care services and the municipal elder care participated in the project. The general aims of the project were to: a) investigate the prerequisites for development and learning; b) test and evaluate interventions at a workgroup level; and c) identify the need for new knowledge. The results were expected to be useful for the field research units as well as for the municipal and county eldercare services in their research and development work.I start with a presentation of the theoretical concepts and apply them in order to form a tentative hypothesis on the status of learning and knowledge in elder care. The next section contains a short description of the different parts of the project and the main results are presented. Finally, the results are discussed and related to the conditions and impact of workplace interventions

Job crafting, employee well-being, and quality of care

The main objective is to study the effects of job crafting activities of elder care and nursing home employees on their perceived well-being and quality of care in two European countries, Spain and Sweden. The Job Crafting, the General Health, and the Quality of Care questionnaires were administered to 530 employees. Correlations and hierarchical regression analyses were performed. Results confirm the effects of job crafting on quality of care (r = .291, p < .01; β = .261, p < .01; ΔR 2 = .065, p < .01) and employees' well-being (r = .201, p < .01; β = .171, p < .01; ΔR 2 = .028, p < .01). A positive linear relationship was found between job crafting and well-being in Spain and Sweden and with quality of care in Spain. On the contrary, in Sweden, the relationship between job crafting and well-being was not linear. Job crafting contributes significantly to employees' and residents' well-being. Management should promote job crafting to co-create meaningful and productive work. Cultural effects are proposed to explain the differences found

Cognitive job crafting as mediator between behavioral job crafting and quality of care in residential homes for the elderly

Extending previous studies on job crafting, the aim of the present study is to analyze the effect of job crafting on quality of care in residential homes for elderly people in two European countries (Spain and Sweden). We hypothesize that cognitive crafting could be a consequence of behavioral crafting and that it will mediate the relationship between behavioral crafting and the perception of quality of care. A correlational design was used, with two waves approximately 12 months apart (n = 226). Our results indicate that behavioral job crafting at T1 had an effect on cognitive job crafting at T2, relational job crafting at T1increases quality of care at T2, and the mediation effect of cognitive job crafting. These results indicate that we must differentiate between the two forms of crafting (behavioral and cognitive), not as indicators of the same latent construct, but as aggregates. Additionally, we point out two main implications for managerial practice. First, as relational job crafting has a direct effect on quality of care, it is important to assure an organizational culture oriented towards employees. Secondly, due to the mediation effect of cognitive job crafting, managers should facilitate meaningful work environments. To do so, jobs should be re-designed, increasing skills variety, identity and significance

Spanish and Swedish eldercare managers' influence on employees

Purpose - Hierarchical and flat organizational types are predominant in Spain and Sweden, respectively. To study how managers' commitment and work overcommitment (WOC) affect employee well-being, and job perception in these different countries can shed insight on how to improve eldercare organization. The purpose of this paper was to study the association between eldercare employee exposure to managers' commitment and WOC, and employee mental well-being and job perception and how these associations differed between Spain and Sweden. Design/methodology/approach - A questionnaire with validated questions on commitment, WOC, mental well-being and job perception, operationalized as the perception of quality of care and turnover intent, was sent out to eldercare managers and employees in Spain and Sweden. t-Tests, χ2 and linear regression were applied to study the associations and differences between the countries. Findings - Interaction analyses revealed that Spanish employees' mental well-being and job perception were influenced by their managers' commitment and WOC in that manager commitment improved and WOC impaired well-being and job perception. However, the Swedish eldercare employees were not influenced by their managers on these parameters. Practical implications - The impact of managerial commitment and WOC differed between employees in Spain and Sweden, possibly because the preconditions for leadership varied due to differences in organizational type. Originality/value - This study compares the managers' impact on employee health and job perception in two countries with different organizational prerequisites. Moreover, managers' commitment and WOC were estimated by the managers themselves and did not rely on the employees' perception, which improved ecological validit

The balancing act - licensed practical nurse experiences of falls and fall prevention: a qualitative study

Artikkelen rapporterer en studie hvor hensikten var å beskrive hjelpepleiere (licensed practical nurses) sine erfaringer med å forutsi og forhindre ytterligere fall når man jobber med pasienter som hadde opplevd et fallrelatert brudd.Background: falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients. Methods: a qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analysed using qualitative content analysis. Results: the result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer. Conclusions: differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies

The balancing act - licensed practical nurse experiences of falls and fall prevention: a qualitative study

Artikkelen rapporterer en studie hvor hensikten var å beskrive hjelpepleiere (licensed practical nurses) sine erfaringer med å forutsi og forhindre ytterligere fall når man jobber med pasienter som hadde opplevd et fallrelatert brudd.Background: falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients. Methods: a qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analysed using qualitative content analysis. Results: the result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer. Conclusions: differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies

Organizational change and commitment: Effects on well-being, turnover intent and quality of care in Spanish and Swedish eldercare

Frequent organizational changes have been a rule rather than an exception in many European countries for decades. The present study investigates how affective organizational commitment relates to and moderates the effects of having been exposed to organizational restructuring on employee well-being, quality of care and turnover intentions among 530 eldercare employees in Sweden and Spain. The results show that there was a main effect of employees' experiences of being affected by change on well-being and turnover intentions but not on quality of care. Restructuring changes were moderated by affective commitment on turnover intentions. However, the buffering effect of affective commitment in terms of protecting employees from turnover intentions was weak

Cold wind of change: Associations between organizational change, turnover intention, overcommitment and quality of care in Spanish and Swedish eldercare organizations

Aim: To examine the association between organizational change, turnover intentions, overcommitment, and perceptions of quality of care among nurses and nursing assistants employed in older people care organizations. Design: A longitudinal survey (baseline, 12 month follow-up) was used. Methods: A panel sample of 226 older people care employees in Spain and Sweden responded to survey questions concerning organizational change, turnover intentions, overcommitment, and perceptions of quality of care. The data was analysed using structural equational modelling. Results: We found a statistically significant positive relationship between organizational change, employees' turnover intention, and overcommitment. We also found a statistically significant negative relationship between organizational change and perceived quality of care

Job crafting and well-being in the elderly care sector: the effect of over-commitment

Purpose - The purpose of this paper is to analyze the moderation effect of over-commitment in the job crafting - well-being relationship, in the elderly care sector in Spain. Design/methodology/approach - A cross-sectional design was implemented and a final sample of 353 participants were assessed using the Job Crafting Questionnaire, an adaptation of the Over-commitment Scale from the Effort-Reward Imbalance Questionnaire, and the General Health Questionnaire (GHQ-12). Findings - A positive interaction between relational and task crafting and over-commitment is observed in the prediction of well-being levels. Specifically, the effect of over-commitment in the task crafting - well-being relationship proved to be statistically significant when opposed to low, medium and high levels of over-commitment. Additionally, the effect of over-commitment in the relational crafting - well-being relationship proved to be statistically significant only when opposed to medium and high levels of over-commitment. Finally, a direct and simple effect was observed between cognitive crafting and well-being, not moderated by over-commitment. Research limitations/implications - Implementation of non-behavioral measurements, and a non-longitudinal design are suggested. The development of behavioral measures for job crafting is encouraged, along with the implementation of longitudinal designs sensitive to changes in over-commitment. Possible over-commitment results are biased by an economically contracted environment. Practical implications - Job crafting training, over-commitment early detection and further research on job crafting strategies ' preferences are suggested. Originality/value - The moderating role of over-commitment in the job crafting - well-being relationship in the elderly care sector represents one of these attempts to better understand evidences of how work-related efforts modify a worker ' s psychological functioning and adaptation, which is the reason why, specially in contexts of uncertainty, its study becomes relevant