Factors that expose nurses to patient aggression in psychiatric and nonpsychiatric settings – an observational study

The overall aim of this study is to describe nurses’ individual characteristics and relationship and work environment factors that expose them to patient aggression in psychiatric and non-psychiatric care settings (emergency, and medical and surgical specialties). The Socio-Ecological Model for the prevention of patientto-worker aggression in hospitals was used as a theoretical framework. The setting of this study was made up of the 21 hospitals that were included in the Finnish Public Sector Study. The participants were the nurses who participated in the Finnish Public Sector Study in 2012 and 2015. First, the extent of the problem was described by determining the occurrence, characteristics and consequences of aggression in psychiatric and two non-psychiatric settings by using cross-sectional data from 5228 nurses. Second, cross-sectional approaches were used to identify how nurses’ individual characteristics, relationship and work environment factors were associated with their experiences of patient aggression in psychiatric specialties (758–923 nurses). Third, a longitudinal approach was used to investigate the associations identified in the cross-sectional analysis, in all three nursing groups (2981 nurses). Different types of statistical methods were used to analyze the data, e.g., descriptive statistics, logistic regression and advanced modeling techniques. The results reveal that aggression was experienced by 41% of nurses (N=5228). The most commonly experienced type of aggression was mental abuse, and the rarest type was armed threats. The consequences of aggression in terms of sleep problems and psychological distress may have been more severe in non-psychiatric nursing groups compared to the psychiatric nursing group. Regarding exposing factors, significant associations between nurses’ individual characteristics and patient aggression were identified in the psychiatric, and medical and surgical nursing group, while none were found in the emergency nursing group. In the nonpsychiatric nursing groups, the relationship factor of poor team climate, and the work environment factors of high effort-reward imbalance, high job strain and poor organizational justice at baseline were associated with increased patient aggression at the follow-up. However, these associations differed between the two nonpsychiatric nursing groups. The results of this study show the complex nature of patient aggression in healthcare. Improving nurses’ relationship and work environment factors when aiming to reduce patient aggression may be useful. However, the results of this study indicate that the non-psychiatric care environments may be more vulnerable to patient aggression related to problems at the relationship and work environment levels. More studies are needed to support the findings of the study

Type D Personality and Job Strain as Predictors of Job Satisfaction

The aim of this study was to test the associations between job satisfaction and job strain, defined according to Karasek's Job Demands-Control Model, as well as type D personality traits. Previous studies have mainly focused on job characteristics and other external circumstances when studying wellbeing at work. The relationship between occupational wellbeing and individual factors such as personality traits has received less attention. Based on previous studies five hypotheses were set: 1) type D personality is associated with lower job satisfaction, 2) type D personality is associated with higher job strain, 3) job strain is negatively associated with job satisfaction, 4) job control moderates the association between job demands and job satisfaction, and 5) the association between type D personality and job satisfaction is mediated by job strain. The data consisted of 1117 participants of the Cardiovascular Risk in Young Finns study. All participants were full-time employed Finns aged 30 to 45. Type D personality was measured with a modified questionnaire based on DS14 (Denollet, 2005), job control was measured using items from the Job Content Questionnaire (Karasek, 1985) and job demands was measured using items from the Occupational Stress Questionnaire (Elo et al, 1990). Job satisfaction was measured with a single-item scale. The hypotheses were tested using linear regression analyses. The effects of gender and education level were controlled for. Employees with type D personality were found to experience lower job satisfaction and higher job strain when compared to non-type D counterparts. Of the two type D traits, only negative affectivity was a statistically significant predictor of job satisfaction. Job strain was associated with lower job satisfaction. The association between negative affectivity and job satisfaction was partly mediated by job strain. Based on these results it seems that type D personality, especially negative affectivity and job strain may be risk factors for lower occupational well-being.Tämän tutkimuksen tavoitteena oli selvittää, ovatko Karasekin Työn hallinta-vaatimukset -mallin mukainen työkuormitus ja D-tyyppinen persoonallisuus yhteydessä työtyytyväisyyteen. Aiempi tutkimus on painottanut työhyvinvoinnin selittäjinä työn ja työympäristön ominaisuuksia. Työntekijän yksilöllisten ominaisuuksien kuten persoonallisuustekijöiden yhteyttä työhyvinvointiin on tutkittu vähemmän. Aiemman tutkimuksen perusteella asetettiin viisi hypoteesia: 1) D-tyyppinen persoonallisuus on yhteydessä matalampaan työtyytyväisyyteen, 2) D-tyyppinen persoonallisuus on yhteydessä korkeampaan työkuormitukseen, 3) työkuormitus on yhteydessä matalampaan työtyytyväisyyteen, 4) työn hallinnan mahdollisuudet moderoivat työn psykologisten vaatimusten ja työtyytyväisyyden välistä yhteyttä ja 5) työkuormitus medioi D-tyypin persoonallisuuden ja työtyytyväisyyden välistä yhteyttä. Aineistona käytettiin Lasten Sepelvaltimotaudin Riskitekijät -tutkimuksen vuoden 2007 aineiston niitä 1117 vastaajaa, jotka olivat vastaushetkellä tehneet täysipäiväistä työtä. D-tyyppinen persoonallisuus mitattiin muokatulla kyselyllä, joka perustuu DS14-mittariin (Denollet, 2005), työkuormituksen ala-asteikoista työn hallinnan mahdollisuuksia mitattiin Job Content Questionnaire -mittarilla (Karasek, 1985) ja työn vaatimuksia Työstressikyselyllä (Elo ym., 1990). Työtyytyväisyyttä mitattiin yksiosioisella mittarilla. Vastaajat olivat iältään 30 – 45 -vuotiaita. Tutkimuskysymyksiä testattiin lineaarisella regressioanalyysillä, jossa huomioitiin sukupuolen ja koulutustason vaikutus. Havaittiin, että D-tyyppiset työntekijät kokivat muita matalampaa työtyytyväisyyttä ja korkeampaa työkuormitusta. D-tyyppisen persoonallisuuden alapiirteistä ainoastaan negatiivinen affektiivisuus oli tilastollisesti merkitsevä selittäjä. Työkuormitus oli yhteydessä matalampaan työtyytyväisyyteen ja välitti negatiivisen affektiivisuuden ja työtyytyväisyyden välistä yhteyttä. Näiden tulosten perusteella vaikuttaa, että D-tyypin persoonallisuus ja etenkin negatiivinen affektiivisuus sekä työkuormitus ovat riskitekijöitä matalammalle työhyvinvoinnille

Työhyvinvoinnin kehittäminen matkatoimistossa : case: Matka-Töysä Oy

Opinnäytetyön tavoitteena oli selvittää millainen työhyvinvoinnin nykytila on toimeksian-tajayritys Matka-Töysä Oy:ssä ja miten työhyvinvointia voidaan yrityksessä kehittää. Opinnäytetyön osana yritykselle laadittiin toimiva kyselylomake säännölliseen työhyvin-vointitutkimukseen. Opinnäytetyössä tutustuttiin tutkimuksen eri vaiheisiin ja työhyvinvoinnin keskeisimpään teoriaan ja tutkimukseen. Tutkimusosassa käytiin läpi tutkimuksen vaiheet ja kyselylo-makkeen vastaukset ja esiin tulleet kehitysideat. Pohdinnassa koottiin tärkeimmät tulok-set sekä pohdittiin tulevia toimenpiteitä toimeksiantajayrityksen työhyvinvoinnin kehit-tämiseksi. Tutkimuksen tiedonkeruumenetelmänä oli kvantitatiivinen kyselylomake, joka hyödynsi myös kvalitatiivisen tutkimusmenetelmän osia. Kysely toteutettiin postikyselynä. Tutki-mus toteutettiin yrityksessä työskennelleille 11 työntekijälle. Kyselyn vastausprosentti oli 82 prosenttia. Kyselyllä selvitettiin työntekijöiden mielipiteitä työhyvinvoinnistaan ja kerättiin kehitysideoita työhyvinvoinnin kehittämiseen. Toimeksiantajayrityksen työntekijät voivat työssään tutkimuksen mukaan hyvin. Eniten kehitettävää löytyy viestinnästä ja esimiestyöstä. Ryhmähenki ja kehittymishalukkuus työssä nähtiin toimeksiantajayrityksen selvänä vahvuutena. Tutkimustuloksia hyödynnetään yrityksen työhyvinvoinnin kehittämisessä. Opinnäyte-työn tuloksia ja sen osana tehtyä työhyvinvointikyselyä hyödynnetään toimeksiantajayri-tyksessä tulevissa työhyvinvointikyselyissä.The purpose of the study was to explore well-being at work at Matka-Töysä Oy Ltd. and find the keys in order to improve well-being at work in the future. The study included creating a questionnaire that organisation can use as part of their annual surveys of well-being at work. The study introduces the research framework, the main models of well-being at work, tools for improving well-being in organisations and the results of the survey and the im-provement tools found. The conclusion compresses the main results and considers the tools for improving well-being in organisations in the future. The study was conducted using a quantitative research method. The survey also took advantage of a qualitative survey method. The data was collected through a mail survey. The target group consisted of the personnel of Matka-Töysä Oy Ltd. The target group included 11 employees, and the response rate was 82 %. The purpose of the study was to explore the personnel’s opinions of their well-being at work and find out ideas of how to improve well-being at work. The results show that team spirit and the employee’s willingness to improve themselves are the definite strengths of the organisation. The results also brought out some targets of development that the organisation should pay attention to in the future. Organisation should pay the most attention to communication and leadership. The results of the study can be exploited for promoting well-being at work at Matka-Töysä Oy Ltd. The organisation can also use the questionnaire as a part of their annual survey. The results of the study can also be compared to the results from the surveys in the future

Economic aspects of smoking : is there a case for government intervention in Finland?.

SIGLEAvailable from British Library Document Supply Centre- DSC:DX79910 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Validation of the Finnish Health Improvement Profile (HIP) with patients with severe mental illness

Background Physical health among people with severe mental illness (SMI) is a global concern. However, many people with SMI do not receive regular comprehensive health checks. There is currently no validated physical health check instrument systematically used in Finnish mental health services. Therefore, this study aims to validate and establish the potential clinical utility of the translated Health Improvement Profile (HIP) tool for Finnish patients with SMI and compare differences in physical health risk items across genders. Methods The content validity of the two-way translated Finnish HIP (HIP-F) was evaluated by five nurses and four patients with SMI using cognitive debriefing (to assess the clarity and relevance of each item and the recommended actions of the HIP tool). The potential clinical utility was assessed using a pilot test involving 47 patients. The prevalence of red-flagged (risk) items in the whole sample, across female and male participants, and the frequencies of any type of missing item response were calculated and analysed using descriptive statistics. A chi-square test was used to determine differences in frequencies of red-flagged items across genders. Results Based on the cognitive debriefing, the HIP-F was found to have moderate content validity regarding the clarity and relevance of the items and recommended actions (the average scale level content validity index, S-CVI/Ave, 0.74). In the pilot test, some missing item responses were identified, but in the sample, nurses identified 399 areas of health and health behaviour risks (mean 8.6 per patient) using the HIP-F. The most frequently red-flagged items were body mass index (BMI) and waist circumference (83.0%), smoking status (48.9%) and lipid levels (46.8%). Female patients had a higher frequency of red-flagged items than males in BMI (92.6% vs. 70.0%, p = 0.04) and waist circumference (96.3% vs. 65.0%, p = 0.01). Conclusions The results demonstrate that the Finnish HIP has moderate content validity and preliminary clinical utility for evaluating the physical health and health behaviours of people with SMI. The HIP-F findings help to sign-post evidence-based interventions for identified areas of concern. Additional nurse training may be necessary to realise the potential clinical utility of the tool in Finland.Peer reviewe

Feasibility, Acceptability, and Preliminary Impacts of Web-Based Patient Education on Patients With Schizophrenia Spectrum Disorder : Quasi-Experimental Cluster Study

Background: Web-based interventions are promising tools for increasing the understanding of illness and treatment among patients with serious mental disorders. Objective: This study aimed to test the feasibility and acceptability of a Web-based patient education intervention using a quasi-experimental cluster design to report feedback on patient education sessions and the website used and to report preliminary evidence of the intervention's impact on patients with schizophrenia spectrum disorder. Methods: A single-blind, parallel, quasi-experimental cluster study over a 6-month period comparing Web-based education (n=33) with a nonequivalent control group (treatment as usual, n=24) for people with schizophrenia spectrum disorder was conducted. Participants (N=57) were recruited from one psychiatric hospital (6 wards). Feasibility was assessed by participants' commitment (refusal rate, dropout rate) to the study. Acceptability was assessed as participants' commitment to the intervention. Patient education sessions and website feedback were assessed by the patients and health care professionals. The preliminary impact of the sessions on patients' self-efficacy, self-esteem, illness cognition, and knowledge level was measured at baseline and follow-ups (8 weeks, 6 months) with self-rated questionnaires. Results: The refusal rate among patients was high with no statistically significant difference (69% [74/107] in the intervention group, 76% [76/100] in the control group; P =.21). The same result was found for the dropout rates (48% [16/33] vs 58% [14/24]; P=. 46). The acceptability of the intervention was good; 31 participants out of 33 (94%) completed all five sessions. Feedback on the intervention was mainly positive; three out of four subscales of session were rated above the midpoint of 4.0. Feedback on the website was also positive, with a grade of good for content (69%, 20/29 patients; 75%, 21/28 professionals), layout (62%, 18/29 patients; 61%, 17/28 professionals), and usability (62%, 18/29 patients; and 68%, 19/28 professionals). The patients using the intervention had significantly higher scores 6 months after the sessions in self-efficacy (baseline mean 26.12, SD 5.64 vs 6-month mean 29.24, SD 6.05; P=.003) and regarding knowledge level about schizophrenia (mean 11.39, SD 4.65 vs 6-month mean 15.06, SD 5.26; P=. 002), and lower scores in the subscale of helplessness in illness cognition (mean 2.26, SD 0.96 vs 6-month mean 1.85, SD 0.59; P=.03). Differences from the control group were not significant. No differences were found in patients' self-esteem or other subscales in illness cognition. Conclusions: The patients were reluctant to participate in the study and tended to drop out before the follow-ups. Once they had participated, their acceptance of the intervention was high. A more effective recruitment strategy and monitoring method will be needed in future studies. To assess the impact of the intervention, a more rigorous study design with an adequately powered sample size will be used in cooperation with outpatient mental health services.Peer reviewe

Work Stress and Satisfaction with Leadership Among Nurses Encountering Patient Aggression in Psychiatric Care : A Cross-Sectional Survey Study

We examined the associations between work stress (job strain, effort-reward imbalance), perceived job insecurity, workplace social capital, satisfaction with leadership and working hours in relation to the likelihood of encountering patient aggression (overall exposure, assaults on ward property, mental abuse, physical assaults). We conducted a cross-sectional survey for nurses (N = 923) in 84 psychiatric units. Both work stress indicators were associated higher odds for different types of patient aggression. Poorer satisfaction with leadership was associated with higher odds for overall exposure to patient aggression. These findings were robust to adjustment for several nurse and work characteristics, and unit size.Peer reviewe

Ehdotukset sosiaali- ja terveydenhuollon rahoituksen kehittämiseksi

Julkaisuun sisältyvät, talousneuvoston sihteeristön tilaamat asiantuntijaraportit porautuvat sosiaali- ja terveydenhuollon rahoituksen ajankohtaiseen problematiikkaan, muun muassa väestökehitykseen ja monikanavaisuuteen liittyviin haasteisiin. Professori Hannu Valtosen laatima raportti Terveydenhuollon rahoitusehdotusten arviointi vertailee julkisuudessa esillä olleita sosiaali- ja terveydenhuollon vaihtoehtoisia kehitysmalleja. Raportti nostaa myös esiin potentiaalisesti tärkeitä näkökohtia, jotka ovat jääneet ehdotuksissa vähälle huomiolle. THL:n asiantuntijaryhmän raportti Sosiaali- ja terveydenhuollon rahoituksen kehittäminen: Kohti yksikanavaista alueellista järjestäjä-rahoittajaa konkretisoi ja kehittää edelleen yhtä vertailussa mukana ollutta mallia. Raportti sisältää myös kuvauksen nykyisen rahoitusjärjestelmän pääpiirteistä sekä järjestelmien kansainvälistä vertailua