Burnout in health-care professionals during reorganizations and downsizing. A cohort study in nurses

Background: Burnout is a psychological reaction triggered by interaction between personal characteristics and stress factors. Reorganizations and downsizing with increased workload imply stress for health-care professionals. This is a study of burnout in nurses during a period with two comprehensive reorganizations. Methods: In this quasi-experimental retrospective cohort study, burnout was assessed in nurses with long work experience in three surveys during a 30 months' period with two comprehensive reorganizations and downsizing of a hospital unit with mostly seriously ill patients with cancer. Burnout was measured with Bergen Burnout Indicator (BBI) at each survey, and "Sense of Coherence" (SOC) with Antonovsky's questionnaire at the last survey. Results: One man and 45 women aged 30 to 65 years were invited to the surveys. There was a significant increase in burnout during the study period, the mean increase in BBI-score was 12.5 pr year (p<0.001). The proportion of satisfied nurses at the first and last survey were 84% and 35% respectively, and the proportions with burnout were 0% and 29% respectively (p<0.001). Except for auxiliary nurses with experience from the medical department, all subgroups experienced a significant increase in BBI. Burnout was associated with low SOC (p<0.001, r square 0.33). Conclusions: There was a significant development of burnout in a group of nurses during a period with two reorganizations and downsizing. Burnout was associated with low SOC. Working with seriously ill patients with cancer has probably made the nurses exceptionally vulnerable to the stress and workload related to the reorganizations

Qualified and Unqualified (N-R C) mental health nursing staff - minor differences in sources of stress and burnout. A European multi-centre study

<p>Abstract</p> <p>Background</p> <p>Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care.</p> <p>Methods</p> <p>A total of 196 nursing staff - 124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds - working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ).</p> <p>Results</p> <p>(a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems.</p> <p>Conclusion</p> <p>The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).</p

Moniulotteinen hoitotyön johtajuus ja hoitohenkilöstön työuupumus terveydenhuollossa

Abstract The purpose of the study was to examine the relationship between nursing leadership and burnout among nurses in health care as well as the incidence of multidimensional leadership and burnout in Finnish nursing. A further purpose was to test a factor structure of Multifactor Leadership Questionnaire (MLQ) and Maslach Burnout Inventory (MBI) in Finnish health care. The empirical data were gathered by postal questionnaires from nursing staff working in university, central and district hospitals, health centers as well as psychiatric and private hospitals (n = 900, response rate 73%). In addition, a follow-up study was performed at a one-year interval (n = 100, response rate 79%). After deleting unusable questionnaires, the sample consisted of 627, and the follow-up study of 78 nurses and nurse leaders. The data were analyzed with descriptive and multivariate statistical methods. Nurse leaders proved to be transformational leaders who rewarded their subordinates, but traditional active and passive management-by-exception and laissez-faire leadership also appeared in their leadership behavior. Half of the nursing staff were moderately burned out and about one tenth were highly burned out. Nearly one fifth suffered from high emotional exhaustion. Nursing leadership has both positive and negative effects on burnout among nursing staff. Rewarding transformational leadership and active management-by-exception functioned as protecting factors, and passive laissez-faire leadership as an exposing factor. However, the results suggest that the relation between leadership and burnout is complex, affected by situational factors of leadership and the ambiguous nature of burnout. The six- and three-factor structure of the MLQ as well as the three-factor structure of the MBI were empirically supported. According to psychometric properties both instruments are well applicable to Finnish health care research. The results can be used in academic leadership education and leadership training in health care organizations, as well as to improve the quality of work life and to promote work well-being. The results can also be utilized in studies applying MLQ and MBI as well as when exploring factor structure of measures and in validation studies of instruments.Tiivistelmä Tutkimuksen tarkoituksena oli selvittää hoitotyön johtajuuden ja hoitohenkilöstön työuupumuksen yhteyttä terveydenhuollossa sekä moniulotteisen johtajuuden ja työuupumuksen esiintymistä suomalaisessa hoitotyössä. Lisäksi tarkoituksena oli testata suomalaisessa terveydenhuollossa moniulotteisen johtajuusmittarin ja kolmiulotteisen työuupumusmittarin rakennetta. Empiirinen tutkimusaineisto kerättiin postikyselyllä yliopisto-, keskus- ja aluesairaaloiden, terveyskeskusten sekä psykiatristen ja yksityisten sairaaloiden hoitohenkilöstöltä (n = 900, vastausprosentti 73). Lisäksi toteutettiin seurantakysely vuoden intervallilla (n = 100, vastausprosentti 79). Aineistosta jouduttiin poistamaan vastauksia, ja poistojen jälkeen tutkimusjoukko muodostui 627:stä ja seurantakyselyssä 78 hoitajasta ja hoitotyön esimiehestä. Aineiston analyysissä käytettiin tilastollisina kuvailevina menetelminä ristiintaulukointia, kontingenssikerrointa, χ²-testiä, Pearsonin tulomomenttikorrelaatiokerrointa, t-testiä, Mann-Whitney U-testiä, Wilcoxonin testiä, yksi- ja kaksisuuntaista varianssianalyysiä sekä Kruskal-Wallisin testiä. Monimuuttujamenetelminä olivat rakenneyhtälömallitus ja lineaarinen regressioanalyysi. Mittareiden luotettavuuden arvioinnissa käytettiin eksploratiivista ja konfirmatorista faktorianalyysiä, Cronbachin alpha -kerrointa, osiosummakorrelaatioita, osioiden välisiä korrelaatioita, Pearsonin tulomomenttikorrelaatiokerrointa ja intraclass-korrelaatiokerrointa. Hoitotyön johtajat osoittautuivat työntekijöitä palkitseviksi muutosjohtajiksi, mutta johtamiskäyttäytymisessä esiintyi myös perinteistä työntekijöiden aktiivista ja passiivista valvomista sekä välttävää johtajuutta. Eroja ilmeni johtajan iän, työkokemuksen, työtehtävän ja perustyöhön osallistumisen mukaan. Puolella hoitohenkilöstöstä esiintyi keskimääräistä ja noin kymmenesosalla voimakasta työuupumusta. Voimakkaasta emotionaalisesta väsymyksestä kärsi lähes joka viides. Hoitotyön johtajuudella on sekä myönteisiä että kielteisiä vaikutuksia hoitohenkilöstön työuupumuksen kannalta. Palkitseva muutosjohtajuus ja työntekijöiden aktiivinen valvominen toimivat työuupumukselta suojaavina tekijöinä ja passiivinen välttäminen työuupumukselle altistavana tekijänä. Tulokset viittaavat kuitenkin siihen, että johtajuuden ja työuupumuksen yhteys on kompleksinen, ja tähän vaikuttavat johtajuuden tilannetekijät ja työuupumuksen moniselitteinen luonne. Hoitohenkilöstön ikä, työllisyystilanne, työaikamuoto ja työtehtävän luonne vaikuttivat johtajuuden ja työuupumuksen yhteyteen, joka oli suhteellisen pysyvä vuoden intervallilla mitattuna. Myös johtajuus ja työuupumus osoittautuivat stabiileiksi ilmiöiksi. Johtajuusmittarin kuuden ja kolmen faktorin rakenne sekä työuupumusmittarin kolmen faktorin rakenne saivat empiiristä tukea. Mittareita voidaan pitää psykometristen ominaisuuksiensa perusteella suomalaiseen terveydenhuoltotutkimukseen soveltuvina. Tutkimustuloksia voidaan hyödyntää terveydenhuoltoalan yliopistollisessa ja terveydenhuollon organisaatioiden sisäisessä johtamiskoulutuksessa, työelämän laadun parantamisessa ja työhyvinvoinnin edistämisessä, johtajuus- ja työuupumusmittaria soveltavissa tutkimuksissa sekä laajemmin mittareiden kehittämistyössä ja validointitutkimuksissa

Subjective unmet needs for school health services among adolescents with different disabilities:a population-based study in Finland

Abstract Background: Subjective perceptions of unmet needs for health services among adolescents with different disabilities remain largely unstudied, even though various international conventions on the rights of people with disabilities oblige signatory governments to improve the equality of access to services. Aims: The aim the study was to examine the need for, and accessibility to, support and help from school health services among adolescents with different disabilities. A second aim was to determine whether these unmet needs are related to certain sociodemographic factors. Methodology: A nationwide, population-based cross-sectional study design was used. The data were collected from the 2017 School Health Promotion study in Finland. The study population consisted of 72,994 8th and 9thgrade adolescents (aged 14–16) who responded to a web survey, reflecting a response rate of 63%. The data were analyzed by cross-tabulation, chi-square tests and logistic regression. Results: The most common self-reported disabilities among adolescents were difficulties in remembering and learning (6–7%). However, a troubling 18–29% of adolescents with major difficulties reported that they had needed support from a school health nurse but had not received it. Moreover, 26–36% of adolescents with difficulties who had needed support from a physician had not received it. Adolescents with disabilities have approximately two- or three-fold higher risks of unmet needs than adolescents without disabilities. Adolescents with difficulties concentrating showed an over three-fold higher risk for unmet needs than other adolescents. The identified differences were evident even after sociodemographic factors were controlled for. Conclusions: Disabled adolescents may well have more health needs than other adolescents, and some of these needs may be unidentified. Thus, disabled adolescents may not receive the support and help they require. In this respect, there are challenging differences between adolescents with and without disabilities

Huono johtaminen:ja hyvät uutiset

Tiivistelmä Huono johtaminen lisää terveysalan henkilöstön irtisanoutumisaikomuksia eli karkottaa ihmisiä alalta tehokkaasti. Hyvä uutinen on, että kehittämällä johtamista henkilöstön työuria voidaan pidentää

Leadership in the context of digital health services:a concept analysis

Abstract Aim: To define and clarify the concept of leadership in the context of digital health services using Walker’s and Avant’s concept analysis model. Background: Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research. Method: Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO) and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents or consequences of leadership in the study context. A total of 4037 references were identified; 23 were included. Results: Leadership attributes concerned leaders’ behaviour, roles and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity and education. Consequences related to organization, professionals and patient and care. Conclusion: Based on our results, the term ’leadership’ should be more widely utilized in nursing practice and research. Implications for nursing management: Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth and benefit clinicians and patients

Toimintarajoitteisilla nuorilla tyydyttämätöntä tuen ja avun tarvetta koulu- ja opiskeluterveydenhuollosta

Tiivistelmä Kansainväliset lapsen ja vammaisten henkilöiden oikeuksia koskevat yleissopimukset velvoittavat parantamaan toimintarajoitteisten nuorten mahdollisuuksia saada palveluja yhdenvertaisesti. Tässä tutkimuksessa tarkasteltiin nuorten tuen ja avun tarvetta ja saantia terveydenhoitajalta ja lääkäriltä toimintarajoitteisilla ja muilla nuorilla sekä erityisesti tyydyttämätöntä tuen ja avun tarvetta sosiodemografisten tekijöiden mukaan. Tutkimuksessa käytettiin valtakunnallisen Kouluterveyskyselyn 2017 aineistoa (n=138 972). Aineisto analysoitiin ristiintaulukoinnilla, χ2-merkitsevyystestillä ja logistisella regressioanalyysillä. Noin 14 prosenttia nuorista arvioi, että heillä oli jokin vakava toimintarajoite eli vaikeuksia näkemisessä, kuulemisessa, liikkumisessa, muistamisessa, oppimisessa tai keskittymisessä. Nuorista, jotka ilmoittivat tarvinneensa tukea ja apua terveydenhoitajalta, kymmenesosa (10%) ei ollut sitä saanut. Tyydyttämätön tuen ja avun tarve oli yleisempää toimintarajoitteisilla (19%) kuin muilla (9%) nuorilla. Lääkäriltä tukea ja apua tarvinneista nuorista noin joka kuudes (16%) ei ollut saanut sitä. Tyydyttämätön tuen ja avun tarve oli yli kaksi kertaa yleisempää toimintarajoitteisilla nuorilla (28%) muihin nuoriin verrattuna (13%). Toimintarajoitteisilla nuorilla oli yli kaksinkertainen riski jäädä ilman tarvitsemaansa tukea ja apua muihin nuoriin verrattuna tarkasteltaessa sekä terveydenhoitajalta että lääkäriltä saatavaa tukea ja apua, vaikka sosiodemografiset tekijät vakioitiin. Toimintarajoitteisilla nuorilla on muita nuoria enemmän hyvinvointiin ja terveyteen liittyviä tuen tarpeita, joista osa voi jäädä tunnistamatta, ja nuori voi kokea jäävänsä ilman tukea ja apua. Erot toimintarajoitteisten ja muiden nuorten välillä ovat suuria, mikä on haaste yhdenvertaisuuden toteutumiselle. Koulu- ja opiskeluterveydenhuollolla on keskeinen rooli näiden hyvinvointierojen kaventamisessa ja yhdenvertaisuuden edistämisessä

Health and social care frontline leaders’ perceptions of competence management in telemedicine in Finland:an interview study

Abstract Aim: This work aims to describe competence management in telemedicine from the perspective of health and social care frontline leaders. Background: The increasing use of services in health and social care is a challenging aspect of modern telemedicine; it requires staff to develop relevant professional competence and good telemedicine practices. Methods: The study was conducted using thematic interviews of frontline leaders from primary health care, specialized medical care and social care (n = 10) in the spring of 2021. The data were analysed by inductive content analysis. Results: The following main categories were identified: Activities of frontline leaders while managing competence in telemedicine, promotion of community learning, competence management in determining telemedicine content, and recognizing health and social care professionals’ competence in telemedicine. Conclusions: Achieving the goals set for telemedicine requires ensuring that knowledge from leaders is widely disseminated and shared and that staff are adequately trained. The results can be utilized in the practical work of other telemedicine and in the development of their operations. Implications for Nursing Management: Managing competence in telemedicine requires from the leaders an encouraging attitude and improved personal interactions in the work community