Identifying work ability promoting factors for home care aides and assistant nurses

<p>Abstract</p> <p>Background</p> <p>In workplace health promotion, all potential resources needs to be taken into consideration, not only factors relating to the absence of injury and the physical health of the workers, but also psychological aspects. A dynamic balance between the resources of the individual employees and the demands of work is an important prerequisite. In the home care services, there is a noticeable trend towards increased psychosocial strain on employees at work. There are a high frequency of work-related musculoskeletal disorders and injuries, and a low prevalence of sustainable work ability. The aim of this research was to identify factors promoting work ability and self-efficacy in care aides and assistant nurses within home care services.</p> <p>Methods</p> <p>This study is based on cross-sectional data collected in a municipality in northern Sweden. Care aides (n = 58) and assistant nurses (n = 79) replied to a self-administered questionnaire (response rate 46%). Hierarchical multiple regression analyses were performed to assess the influence of several independent variables on self-efficacy (model 1) and work ability (model 2) for care aides and assistant nurses separately.</p> <p>Results</p> <p>Perceptions of personal safety, self-efficacy and musculoskeletal wellbeing contributed to work ability for assistant nurses (R²adj of 0.36, <it>p </it>< 0.001), while for care aides, the safety climate, seniority and age contributed to work ability (R²adj of 0.29, <it>p </it>= 0.001). Self-efficacy was associated with the safety climate and the physical demands of the job in both professions (R²adj of 0.24, <it>p </it>= 0.003 for care aides), and also by sex and age for the assistant nurses (R²adj of 0.31, <it>p </it>< 0.001).</p> <p>Conclusions</p> <p>The intermediate factors contributed differently to work ability in the two professions. Self-efficacy, personal safety and musculoskeletal wellbeing were important for the assistant nurses, while the work ability of the care aides was associated with the safety climate, but also with the non-changeable factors age and seniority. All these factors are important to acknowledge in practice and in further research. Proactive workplace interventions need to focus on potentially modifiable factors such as self-efficacy, safety climate, physical job demands and musculoskeletal wellbeing.</p

Effects of work ability and health promoting interventions for women with musculoskeletal symptoms: A 9-month prospective study

<p>Abstract</p> <p>Background</p> <p>Women working in the public human service sector in 'overstrained' situations run the risk of musculoskeletal symptoms and long-term sick leave. In order to maintain the level of health and work ability and strengthen the potential resources for health, it is important that employees gain greater control over decisions and actions affecting their health – a process associated with the concept of self-efficacy. The aim of this study was to describe the effects of a self-efficacy intervention and an ergonomic education intervention for women with musculoskeletal symptoms, employed in the public sector.</p> <p>Methods</p> <p>The design of the study was a 9-month prospective study describing the effects of two interventions, a comprehensive self-efficacy intervention (<it>n </it>= 21) and an ergonomic education intervention (<it>n </it>= 21). Data were obtained by a self-report questionnaire on health- and work ability-related factors at baseline, and at ten weeks and nine months follow-up. Within-group differences over time were analysed.</p> <p>Results</p> <p>Over the time period studied there were small magnitudes of improvements within each group. Within the self-efficacy intervention group positive effects in perceived work ability were shown. The ergonomic education group showed increased positive beliefs about future work ability and a more frequent use of pain coping strategies.</p> <p>Conclusion</p> <p>Both interventions showed positive effects on women with musculoskeletal symptoms, but in different ways. Future research in this area should tailor interventions to participants' motivation and readiness to change.</p

Arbetsvillkor och arbetsbelastning i journalistiskt arbete : en studie av tidningsredaktioner

Working conditions and work load in journalistic work a study of editorial offices The circumstances this study aimed to shed light on were differences between male and female journalists, between journals of different size and between editorial work in a big city and a provincial town. We have been studying whether, and in that case how, working conditions and health for women and men have been influenced by the integration of the sexes that has taken place parallel to technological development Questionnaires for self-evaluation, interviews and observation were used as methods to analyze working conditions, workload and health. One big, one medium sized and one small daily newspaper were included in the study. A total of 317 answered the questionnaire, while in two of the news offices 24 journalists were interviewed and observed with regard to their working conditions and health. Since this is a cross-sectional and relatively small study, there is not enough material to draw far- reaching conclusions. Most newspapers today are working under economic pressure, a fact that has an impact on staffing and hence workload in the editorial office. In general terms the size of the newspaper seems not very decisive for what working conditions look like. But the worse the economic situation, the more demanding gets the working situation of the journalists. Yet, even for journalists who work in an economically prosperous company with high set goals of profitability, the working environment is far from being optimal. Journalistic work is intense in terms of knowledge and creativity. Of journalists in this study, a great majority report that they experience their work as very interesting. The journalists employed at the smallest provincial newspaper are the group that is the most satisfied with their work. The job requires great planning and organisational capacity, to master large unities, taking initiative and making independent decisions. Our study shows that an individual s responsibility for a successful outcome of his or her work is of great importance. A majority considers that they have enough responsibility in relation to what they know. They also feel they have freedom to decide over their own work. But the part who consider that they have considerable influence over the course of events at the job is in general less than half. We found a clear difference between generations with regard to possibilities for influence. Some of the older editors, with long periods of employment, enjoy a more independent position with a high degree of decision-making power as to the newspaper s contents. As a profession journalism has for long been male dominated, but is now showing a bigger share of women. Between 1989 and 2000 the share of women rose from 34 to 47 percent and the increase seems to be going on. Through this, the journalist profession has become one of the few professions with a balanced gender division. Earlier studies indicate that the gender division between different positions in news offices is in principle equivalent to the labour market at large. Today s situation is according to our study to a certain degree still marked by a traditional gender order. Patterns of gender segregation in the newspapers show differences. The changed gender composition of the profession has not left any traces on the higher echelons of the companies. This is true especially for the two smaller newspapers, which in conformity with other provincial newspapers are managed by men. Profile illustrations indicate similar patterns for the editorial offices we studied. Time pressure is surprisingly identical irrespective of financial status, number of employees and circulation. It is the everyday production process of a new issue that controls the work environment. Pressure to produce quickly is as high for the slimmed organisation of the big city newspaper, which is competing on a tough media market, as for the small newspaper that struggles for survival. Similar to working life at large the tendency is an increasing pace of work. Quite clearly IT has an impact on the production and work within the media. Our study showed that time spent with intense computer work was very high at all three editorial offices. On the average 63 percent of the women and 61 percent of the men worked more than 20 hours per week at the computer. The more tied to the computer, the higher the risk of developing problems (pain) in the skeleton, joints and muscles. High pressure in time indicates high demands. Evaluations of stress levels in our study indicated co-variations with the level of demands in this respect. The connection between stress evaluation and ailments were a rather general feature for all the three editorial offices and most blatantly for the women. The profiles are showing the importance of the different health variables. Health results are different for women and men. The work situation does not explain the entire difference in health outcomes. What also seems to be important is that the physical design of the workplaces is not adapted to women to a sufficient degree.De förhållanden som studien belyser är bl.a. skillnader mellan könen, mellan de olika stora tidningarna och mellan journalistiskt arbete i storstad och på landsorten. Vi har undersökt om och i så fall hur arbetsvillkoren och hälsoläget för kvinnor och män påverkats av den könsmässiga integrering som skett samtidigt med den tekniska utvecklingen. Självskattningsformulär, intervjuer och observationer användes som metoder för analysen av journalisternas arbetsvillkor, arbetsbelastning och hälsa. I studien ingick en stor, en medelstor och en liten dagstidning. Totalt 317 personer enkätintervjuades och på två av tidningarna intervjuades och observerades 24 journalister beträffande sina arbetsvillkor och hälsa. Vi har inte tillräckligt stort underlag för att kunna dra långtgående slutsatser. De flesta tidningar idag är ekonomiskt pressade och det påverkar bemanningen och därmed arbetsbelastningen på redaktionerna. Generellt sett förefaller inte tidningens storlek vara helt avgörande för hur arbetsvillkoren ser ut. Ju sämre ekonomin är desto mer krävande blir journalisternas arbetssituation. Men även för journalister i ett ekonomiskt välmående företag som drivs med höga lönsamhetsmål är arbetsmiljön långt ifrån den optimala. Det journalistiska arbetet är kunskapsintensivt och kreativt. En stor majoritet av journalisterna i denna studie anger att de upplever själva arbetet som mycket intressant. Journalisterna på den minsta landsorttidningen är den grupp som är mest nöjd med sitt arbete. Arbetet förutsätter stor förmåga att organisera och planera, att behärska stora helheter, att ta initiativ och att fatta självständiga beslut. Vår studie visar att individen och dennes ansvar för sina arbetsresultat har stor betydelse. De flesta anser sig ha tillräckligt stort ansvar i förhållande till det de kan och tycker att de kan bestämma över sitt eget arbete. Andelen som anser sig har stort inflytande över vad som händer på jobbet är däremot i regel mindre än hälften. Vi kunde konstatera en tydlig skillnad i möjligheten till inflytande mellan generationer där några äldre redaktörer med lång anställningstid har en självständigare position med ett stort beslutsutrymme vad gäller innehållet i tidningen. Journalistyrket är ett yrke som länge var mansdominerat men där kvinnorna nu blivit allt fler. Mellan 1989 och 2000 ökade andelen kvinnor i journalistkåren från 34 till 47 procent och ökningen ser ut att fortsätta. Journalistyrket är därmed ett av få yrkesområden med en balanserad könsfördelning. Tidigare studier visar att könsfördelningen för olika befattningar på tidningarna i princip är densamma som på arbetsmarknaden i övrigt. Vår studie visar att dagens situation på de undersökta redaktionerna i viss mån fortfarande är präglad av traditionell könsordning. De könssegregerade mönstren på tidningarna skiljer sig åt. Den förändrade könssammansättningen inom yrket har inte satt spår i toppen på företagen, framförallt inte på de två mindre tidningarna, som i likhet med övriga landsortstidningar, är styrda av män. Profilillustrationerna antyder att ett likartat mönster gäller för de undersökta redaktionerna. Tidspressen är förvånansvärt lika oavsett tidningens ekonomi, antalet anställda och upplaga. Den dagliga produktionsprocessen mot en ny tidning styr arbetsmiljön. Trycket är stort att producera snabbt såväl på en storstadstidning som slimmats och som konkurrerar på en allt tuffare mediemarknad, som på en liten andratidning som kämpar för sin överlevnad. Liksom i arbetslivet i stort verkar tendensen vara ett ökande arbetstempo. IT påverkar produktion och arbete inom medier. I vår undersökning framgick det att den tid som tillbringades med datorintensivt arbete var mycket hög vid alla tre redaktionerna. I genomsnitt arbetade 63 procent av kvinnorna och 61 procent av männen mer än 20 timmar per vecka med datorn. Ju mer bunden vid datorn, desto större är risken att utveckla besvär i skelett, leder och muskler. Hög tidspress tyder på höga krav. Stresskattningarna visade i vår studie tecken på samband med kravnivån i detta hänseende. Sambanden mellan stresskattningarna och besvär var genomgående rätt tydliga för alla tre redaktionerna och tydligast var de för kvinnorna. Profilerna visar variablernas betydelse sinsemellan. Hälsoutfallet skiljer sig för kvinnor och män. Arbetssituationen kan inte förklara hela skillnaden i hälsoutfallet. Arbetsplatsernas fysiska utformning är inte i tillräckligt hög grad anpassad för kvinnor

Assessment of physical work load at visual display unit workstations : Ergonomic applications and gender aspects

From the department of Occupational Health, Karolinska Hospital, Stockholm, Department of Ergonomics, National Institute for Working Life, Solna, and the Department of Surgical Sciences K3, Section for Rehabilitation Medicine, Karolinska Institute, Stockholm. Assessment of physical work load at visual display unit workstations Ergonomic applications and gender aspects Lena Karlqvist Arbete och Hälsa I997:9 .Local physical workload at visual display unit(VDU) workstations with different lay-out and computer input devices were studied among men and women. Word processing with keyboard only and a computer mouse were compared. "Mouse" operators worked longer time in stenuous working postures than "non mouse" operators and they corrected a longer text during the given time. The intra and intermethod reliability of a questionnaire for estimation of physical load in word-processing workwas tested. Self-reported duration of VDU work and mouse use had a good intramethod reliability, and self-reports on location of key-board and mouse on the work table had a good intermethod reliability when compared with direct measurements. In a cross-sectional study female CAD-operators reported a higher prevalence of musculoskeletal symptoms than their male colleagues despite the same education/training, workcontent and self-reported physical load. Location of the mouse outside an "optimal" area on the work table and/or long duration of mouse-use were associated with higher prevalence of upper limb symptoms. An experimental study was designed to determine posture, muscular load and perceived exertion with six different locations of the computer mouse on the work table. Amouse location on the worktable corresponding to a relaxed, neutral posture of the arm combined with arm support was preferred. Arm support also reduced muscle load in the neck/shoulder region. Comparison of text editing with a mouse and a track-ball showed that work with the track-ball entailed lower shoulder elevation and less shoulder muscle activity, but more wrist extension than work with the mouse. Gender differences in working techniques were observed in the experimental studies and should be subject to further analyses. Development, specification and evaluation of a work table, suitable for VDU work with a non-keyboard computer input device, i. e. a mouse was carried out in collaboration with furniture manufactures, employees and employer. It was shown that the lay-out of a VDU work table, suitable for workwith different input devices should make it possible to support the arms, to vary between sitting and standing postures and to prevent pronounced abduction and outward rotation of the shoulder. Keywords: Gender, input device, physical load, VDU workstation

Från matsal till matlåda : Ergonomiska belastningar vid distribution av portionsförpackad varm mat

From dining room to lunch box: Ergonomic loads in distribution of individually portioned warm food During the last years in Sweden, distribution of warm food have been a service more commonly offered, then other forms of help, by the society to old people living at home who can't prepare their own food anymore. Organisations for this type of distribution have been built up in several Swedish municipalities. In the municipality where the present study took place, the food distributors were working under conditions that their employer thought was very demanding. The research and development program Gender and work, at the National Institute for Working Life, performed a case-study where the main aim was to describe the food distributors psychosocial and physical working conditions, to compare those to other categories of employees, and to suggest solutions to the problems identified. Structured interviews focusing on the psychosocial working conditions and of the employees own suggestions of solutions were performed with five food distributors, three cooks and two cleaners. The physical working conditions were measured through observations, by measuring pulse and walking distance per working day, and by rated perceived excertion. The overall impression from our study is that the food distributors indeed have a very demanding working condition, and that there are several aspects that need to be improved, both in the short and in the long run. The psychosocial working conditions were characterised by high mental demands and low decision latitude, time pressure and dissatisfaction with the fact that they can't live up to the expectations. The measurements of the physical demands showed that the food distributors scored very high on both mean pulse and %HRR, which is a known risk factor for reduced health. The combination of demanding psychosocial and physical working conditions is a cause of worry, at least in the long run. In the performed interviews, there was nothing that indicated that distribution of warm food will decrease further on, rather the opposite. It is therefore important that the working conditions for the food distributors are organised so they can work during a number a years and still remain healthy. A short-run solution to the problem is to employ two more food distributors and lease a third car. Then the total workload would decrease and be more evenly distributed during the day. It is also possible to extend the excepted delivery time from two hours to three hours, which would decrease the time pressure. A long-run solution to the problem is to design combination-positions, where both food distribution and work in the hospital kitchen, and maybe also cleaning, are included. Such combination-positions would make it possible to increase the number of working hours to full-time, which is necessary to be able to live on the salary. The variation over the week will be much greater with such a solution, and the demands more evenly distributed.Under senare år har leverans av matlåda blivit en allt vanligare insats som erbjuds äldre som behöver hjälp med maten. Detta har lett till att verksamheter för tillagning och leverans av varm mat har byggts upp i många kommuner. I den nu studerade kommunen arbetade matdistributörerna under förhållanden som av arbetsgivaren bedömdes vara mycket stressiga och slitsamma. Arbetslivsinstitutets forsknings- och utvecklingsprogram Kön och arbete genomförde därför en fallstudie med en övergripande målsättning att belysa matdistributörernas fysiska och psykosociala arbetsvillkor, relatera dessa till andra personalkategorier inom enheten samt komma med förslag till förbättringar av matdistributörernas arbetsförhållanden. Strukturerade intervjuer om de psykosociala arbetsvillkoren samt om personalens egna idéer och förslag till förbättringar genomfördes med fem matdistributörer, tre kokerskor och två lokalvårdare. De fysiska arbetsvillkoren kartlades genom mätningar av puls och gångsträcka, observationer av en arbetsdag samt självskattad upplevd ansträngning. Helhetsintrycket från vår fallstudie är att matdistributörerna har en mycket besvärlig arbetssituation ur flera aspekter som bör åtgärdas både på kort och lång sikt. Deras psykosociala arbetsvillor kännetecknas av höga krav och små påverkansmöjligheter, tidspress och otillfredsställelse med att inte kunna leva upp till förväntningarna. Mätningarna av den fysiska belastningen visade att matdistributörerna ligger mycket högt vad gäller medelpuls i arbete och %HRR, vilket kan vara en risk för nedsatt hälsa. Kombinationen av påfrestande psykosociala och fysiska arbetsvillkor ger anledning till oro för matdistributörernas hälsa på längre sikt. I de intervjuer som genomförts framkom inga indikationer på att matdistribution som företeelse kommer att minska i omfattning i framtiden. Snarare kommer den att öka i takt med att fler servicehus läggs ned. Det är alltså viktigt att matdistributionen organiseras på ett sådant sätt att det är möjligt att arbeta som matdistributör under en följd av år och ändå vara vid god hälsa. En lösning på kort sikt är att utöka antalet matdistributörstjänster med två samt införskaffa ytterligare en leasingbil. Då skulle den totala belastningen minska och fördelas mer jämt. En annan lösning som kan genomföras snabbt är att utöka leveranstiderna, vilket skulle kunna leda till att matdistributörerna inte känner sig lika tidspressad som för närvarande. En mera långsiktig lösning är att införa kombinationstjänster. Med kombinationstjänster menas att vissa tjänster kan delas mellan att t ex arbeta som köksbiträde vissa dagar och som matdistributör andra dagar. Man kanske även kan tänka sig att dela lokalvårdstjänster och matdistribution. Med kombinationstjänster bör det också vara lättare att skapa heltidstjänster så att alla har möjlighet att leva på sin egen lön. En annan fördel är att arbetet skapar mer variation över veckan. Både den cirkulatoriska belastningen och belastning på muskler, skelett och leder fördelas jämnare

Health-promoting educational interventions: A one-year follow-up study

Aims: The purpose of this study was to describe and analyse the effects of health-promoting educational interventions among employees in a municipality in Sweden. Methods: A randomized controlled educational intervention study was performed with 340 employees. Supervisors and workplace champions took part in two separate educational programmes with focus on health promotion. Intervention groups were teams of supervisors, teams of workplace champions and a mixed group (supervisors and workplace champions). The control group did not take part in any of the activities. Evaluations with physical fitness tests and a self-administrated questionnaire were performed twice. Focus group discussions were held. Results: All groups raised their physical fitness level from baseline to follow-up. Females in the supervisor group had increased their mean maximal oxygen uptake from 32.0 mlO(2)/kg(star)min to 34.9 mlO(2)/kg(star)min which was more than the others. Supervisors had reached increased knowledge within the area 'organizational factors' and behavioural changes had been obtained within the area 'life-style'. Workplace champions working together with their supervisors had an easier and more motivated situation than workplace champions working by themselves. Conclusions: Coaching supervisors as well as the mixed group seemed to improve the intervention of health promotion most and should be continued

Different working conditions and perceived health at Gender Segregated Workplaces : Can health promotion promote equality in work demands?

Godkänd; 2013; 20150313 (andbra

Ergonomic conditions and health at gender segregated workplaces

Purpose: To investigate working conditions and health at gender segregated (most women, ≥ 60% women or most men, ≥ 60% men) workplaces with a focus on associations of ergonomic exposures with musculoskeletal disorders.Methods: A comprehensive questionnaire was randomly sent to 10 000 inhabitants in three municipalities in the middle of Sweden. The response rate was 50% (4965 men and women). Organisational, physical and psychosocial working conditions and the musculoskeletal symptom panorama as well as general health and psychological well-being were compared between men and women in the gender segregated workplaces.Results: There were significant differences in working conditions between men and women both in female and male dominated workplaces. Most differences concerned physical work environment factors at both workplaces. However, the level of low control and strain were more prevalent among women in male dominated workplaces. A significantly greater share of women, compared to men, reported symptoms in all body parts except in low back and knees at both workplaces. Good general health was reported by 80% of both men and women but men in male dominated workplaces perceived significantly better psychological well-being than the others.Conclusions: Women and men in this region performed different work tasks and a greater share of women than men reported musculoskeletal symptoms. This was the fact also when working in the same type of segregated workplaces.Validerad; 2012; 20120618 (andbra)</p

Safety climate and participatory safety activities in municipal home care services

Godkänd; 2011; 20110218 (andbra