Veien mot en heltidskultur i helsesektoren i Mandal Kommune

Masteroppgave ledelse ORG917 - Universitetet i Agder 2018Det har vært en lang og fantastisk reise med det å ha jobbet med temaet heltidskultur i helsesektoren. Jeg har fra jeg begynte å tenke på temaet og problemstillingen omkring heltidskultur lest meg opp på utallige faglige artikler, debatter, innlegg og bøker som omhandler alt fra deltid-heltidsproblematikk, heltidskultur, organisasjonskultur, ulike turnusordninger, endringsledelse og endringsstrategier sammen med refleksjon av egne opplevde kunnskaper og erfaringer. Helsearbeidere, da tenker jeg på sykepleiere og helsefagarbeidere har gått fra deltid – heltid - tilbake til deltid opp gjennom alle årtider og generasjoner, for så å fokusere på heltid igjen per nå. Grunnen til at heltidstanken har vært som en jojo og bølgedal, tenker jeg ligger både i Sørlandskulturen vår (inkludert bibelbeltet) men også i hvordan samfunnets goder har vært tilrettelagt opp gjennom alle tiår. Eksempelvis i 1970, var det lite utbygde barnehager og skolefritidsordningen fantes ikke, ei heller det som i dag heter pappapermisjon. Dermed var kvinnene nødt til enten å kun være hjemmeværende husmor eller å være deltidsarbeidende. Utover i 80- og 90 tallet så ble det bygd flere barnehager og SFO hadde nettopp begynt å fungere, dermed kunne kvinne jobbe litt høyere stillinger en kun 50% eller mindre. Fra 2000 tallet og frem til nå så har også pappapermisjonsordning kommet på plass sammen med utvidet mammapermisjon så fra nå av ligger egentlig alt til rette fra samfunnets side for at kvinner/mødre kan jobbe heltid. Det neste en må fokusere på og jobbe med er kvinners holdninger og innstillinger til å jobbe heltid, Hvorfor velger fortsatt så stor andel kvinner/mødre å jobbe deltid på tross av at alt ligger til rette for heltid? Ut fra tallmateriale jeg fikk fra min arbeidsplass Mandal Sykehjem så jobber kun 28,9 – 42,3 % av den totale arbeidsstokken heltid, og for å få til en heltidskultur så må over halvparten av de ansatte jobbe heltid. Min problemstilling ble dermed; Hva forklarer den høye forekomsten av deltid og hva må til for at flere skal jobbe heltid på Mandal Sykehjem? Gjennom overnevnte undring og refleksjon, så valgte jeg å intervjue enhetsleder, avdelingsledere og hovedtillitsvalgte (som representerer de ansattes synspunkt) om deres syn på heltidskultur, kulturen på Sørlandet, hvilke fordeler/ulemper som finnes omkring heltidskultur og hva de selv kan og vil bidra med for at deres arbeidsplass skal få til en heltidskultur. Mandal kommune engasjerte også en prosjektleder på heltidskultur høsten 2017 og jeg har og nylig vært i kontakt med henne for å høre hvor langt de har kommet i arbeidet med å etablere en heltidskultur på Mandal Sykehjem. Av tiltak som kom frem i intervjuene om hva som kunne gjøres for å få flere til å jobbe heltid, så er årsturnus og langvakter i helgene i henhold til det turnustekniske og jobbing med holdninger og kultur i forhold til de ansatte tiltak som burde settes i verk på sykehjemmet

Reliability and validity of the Norwegian version of the disabilities of the arm, shoulder and hand questionnaire in patients with shoulder impingement syndrome

Background: Patient-rated outcome measures (PROMs) are an important part of clinical decision-making in rehabilitation of patients with shoulder pain. The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire was designed to measure physical disability and symptoms in patients with musculoskeletal disorders of the upper extremity and is one the most commonly used outcome measures for patients with shoulder pain. The purpose of this study was to investigate the reliability and validity of the Norwegian version of the DASH in patients with shoulder impingement syndrome. Methods: Sixty-three patients diagnosed with shoulder impingement syndrome at an orthopaedic outpatient clinic were included in the study. Internal consistency of the DASH was evaluated by the Cronbach’s alpha and item-to-total correlations. Test-retest reliability was analyzed by the intraclass correlation coefficient (ICC) and limits of agreement (LoA) according to the Bland Altman method. Standard error of measurement (SEM) and minimally detectable change (MDC) were calculated for the total DASH score. Construct validity was evaluated by testing six a priori hypotheses for the Pearson’s correlation coefficient between the DASH and the Shoulder Pain and Disability Index (SPADI), the 36-item Short Form Health Survey (SF-36) and a Numeric Pain Rating Scale (NPRS). Results: Reliability: Cronbach’s alpha of the DASH was 0.93 and item-to-total correlations ranged from 0.36 to 0.81. ICC was 0.89. The 95 percent LoA was calculated to be between −11.9 and 14.1. SEM was 4.7 and MDC 13.1. Construct validity: Eighty-three percent of the a priori hypotheses of correlation were confirmed. The DASH showed a high positive correlation of 0.75 with the SPADI, a negative moderate correlation of −0.48 to −0.62 with physical functioning, bodily pain and physical component summary of the SF-36 and a moderate positive correlation of 0.58 with the NPRS. DASH correlated higher with the physical component summary than with the mental component summary of the SF-36. Conclusions: The Norwegian version of the DASH is a reliable and valid outcome measure for patients with shoulder impingement syndrom

Development and Reliability of a Clinician-rated Instrument to Evaluate Function in Individuals with Shoulder Pain: A Preliminary Study

Background and Purpose Subacromial impingement syndrome (SIS) is a common and disabling condition in the population. Interventions are often evaluated with patient-rated outcome measures. The purpose of this study was to develop a simple clinician-rated measure to detect difficulties in the execution of movement-related tasks among patients with subacromial impingement syndrome. Method The steps in the scale development included a review of the clinical literature of shoulder pain to identify condition-specific questionnaires, pilot testing, clinical testing and scale construction. Twenty-one eligible items from thirteen questionnaires were extracted and included in a pilot test. All items were scored on a five-point ordinal scale ranging from 1 (no difficulty) to 5 (cannot perform). Fourteen items were excluded after pilot testing because of difficulties in standardization or other practical considerations. The remaining seven items were included in a clinical test-retest study with outpatients at a hospital. Of these, four were excluded because of psychometric reasons. From the remaining three items, a measure named Shoulder Activity Scale (summed score ranging from 3 to 15) was developed. Results A total of 33 men and 30 women were included in the clinical study; age range 27–80 years. The intraclass correlation coefficient results for inter-rater reliability and test-retest reliability were 0.80 (95% CI = 0.51–0.90) and 0.74 (95% CI = 0.58–0.84), respectively. The standard error of measurement and minimal detectable change were 1.19 and 3.32, respectively. The scale was linked to the International Classification of Functioning, Disability and Health second level categories lifting and carrying objects (d430), dressing (d540), hand and arm use (d445) and control of voluntary movement (b760). Conclusion The Shoulder Activity Scale showed acceptable reliability in a sample of outpatients at a hospital, rated by clinicians experienced in shoulder rehabilitation. The validity of the scale should be investigated in future studies before application to common practice. © 2013 The Authors. Physiotherapy Research International published by John Wiley & Sons Ltd

Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative

Aims: To assess the probability of individuals with early-diagnosed hip or knee osteoarthritis experiencing a fall and/or fracture compared to a cohort without osteoarthritis. Methods: Data were analysed from the Osteoarthritis Initiative dataset. We identified all people who were diagnosed with hip or knee osteoarthritis within a 12 month period, compared to those without osteoarthritis. We determined whether there was a difference in the occurrence of falls, with or without a consequential fractures, between people newly diagnosed with hip or knee osteoarthritis compared to those who had not using odd ratios (OR) and 95% confidence intervals. Results: 552 individuals with hip osteoarthritis were compared to 4244 individuals without hip osteoarthritis. 1350 individuals with knee osteoarthritis were compared to 3445 individuals without knee osteoarthritis. People with knee osteoarthritis had a 54% greater chance of experiencing a fall compared to those without (OR: 1.54; 95% CI: 1.35 to 1.77). People with hip osteoarthritis had a 52% greater chance of experiencing a fall compared to those without hip osteoarthritis (OR: 1.52; 95% CI: 1.26 to 1.84). People with knee and hip osteoarthritis demonstrated over an 80% greater chance of experiencing a fracture in the first 12 months of their diagnosis compared to those without hip or knee osteoarthritis (TKA: OR 1.81; THA: OR 1.84). Conclusions: There is an increased risk of falls and fractures in early-diagnosed knee and hip osteoarthritis compared to those without osteoarthritis. International guidelines on the management of hip and knee osteoarthritis should consider the management of falls-risk

Change in physical activity level and clinical outcomes in older adults with knee pain: a secondary analysis from a randomised controlled trial

BACKGROUND: Exercise interventions improve clinical outcomes of pain and function in adults with knee pain due to osteoarthritis and higher levels of physical activity are associated with lower severity of pain and higher levels of physical functioning in older adults with knee osteoarthritis in cross-sectional studies. However, to date no studies have investigated if change in physical activity level during exercise interventions can explain clinical outcomes of pain and function. This study aimed to investigate if change in physical activity during exercise interventions is associated with future pain and physical function in older adults with knee pain. METHODS: Secondary longitudinal data analyses of a three armed exercise intervention randomised controlled trial. Participants were adults with knee pain attributed to osteoarthritis, over the age of 45 years old (n = 514) from Primary Care Services in the Midlands and Northwest regions of England. Crude and adjusted associations between absolute change in physical activity from baseline to 3 months (measured by the self-report Physical Activity Scale for the Elderly (PASE)) and i) pain ii) physical function (Western Ontario and McMaster Universities Osteoarthritis Index) and iii) treatment response (OMERACT-OARSI responder criteria) at 3 and 6 months follow-up were investigated using linear and logistic regression. RESULTS: Change in physical activity level was not associated with future pain, function or treatment response outcomes in crude or adjusted models at 3 or 6 months (P > 0.05). A 10 point increase in PASE was not associated with pain β = - 0.01 (- 0.05, 0.02), physical function β = - 0.09 (- 0.19, 0.02) or likelihood (odds ratio) of treatment response 1.02 (0.99, 1.04) at 3 months adjusting for sociodemographics, clinical covariates and the trial intervention arm. Findings were similar for 6 month outcome models. CONCLUSIONS: Change in physical activity did not explain future clinical outcomes of pain and function in this study. Other factors may be responsible for clinical improvements following exercise interventions. However, the PASE may not be sufficiently responsive to measure change in physical activity level. We also recommend further investigation into the responsiveness of commonly used physical activity measures. TRIAL REGISTRATION: ( ISRCTN93634563 ). Registered 29th September 2011