Asiakkaiden toimintakyky, työn organisointi ja henkilöstön hyvinvointi vanhusten pitkäaikaisessa laitoshoidossa

HoiToVa-hankkeen osaraportti, toteutettu Työsuojelurahaston ja Suomen Akatemian rahoituksell

Työ vanhuspalveluissa : Näkökulmia työn muotoilusta, stressiteorioista, informaatioprosessoinnista ja organisaatiokulttuureista

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Tutkimuksen tarkoituksena oli analysoida työtä ja henkilöstön hyvinvointia vanhustenhuollossa useista näkökulmista. Tutkimuksessa kuvattiin vanhustenhuollon työtä ja sen ongelmia, selvitettiin stressiä ja työtyytyväisyyttä selittäviä tekijöitä, työn piirteiden ja stressitekijöiden yhteyksiä, asiakkaiden kuntoisuuden, stressitekijöiden, fyysisen kuormittavuuden ja stressioireiden yhteyksiä tuki- ja liikuntaelinten oireisiin sekä kuvattiin työntekijöiden asiakasta koskevaa tietoa ja sen kulttuurisia piirteitä. Tutkimusaineistoina käytettiin henkilöstökyselyä, henkilöstöhaastattelua ja asiakasmittauksia. Tutkimusaineistot kerättiin vanhainkodeista, terveyskeskuksen vuodeosastoilta sekä kotipalvelusta ja kotisairaanhoidosta. Aineistojen analyysiin käytettiin t-testiä, regressioanalyysiä sekä konfirmatorista faktorianalyysiä (LISREL-ohjelma). Laadullisessa osassa työntekijöiden vanhuksia koskevat käsitykset jaettiin kategorioihin sekä kvantifioitiin. Kategorioiden käyttöä ja tietorakenteita analysoitiin korrelaatiotarkastelun avulla. Työ vanhusten laitoshoidossa todettiin sekä psyykkisesti että fyysisesti erittäin kuormittavaksi. Kotihoidossa psyykkisiä ja fyysisiä oireita oli vähemmän. Laitoshoidossa suurimpia ongelmia olivat ergonomiset ongelmat, kiire, asiakassuhteiden rasittavuus, haasteettomuus, työn sirpaleisuus, vähäinen itsenäisyys ja palaute. Eri stressioireita ja työtyytyväisyyttä voitiin selittää pääasiassa eri tekijöillä. Hyvin organisoidulla työllä todettiin voitavan vähentää kiireen tunnetta ja tätä kautta myös fyysistä kuormittavuutta. Työn psykososiaalisten ominaisuuksien yhteyden todettiin kuitenkin välittyvän fyysisiin rasitusoireisiin selkeämmin psyykkisen stressin kuin fyysisen kuormituksen kautta. Asiakkaiden kuntoisuudella todettiin olevan merkitystä kuormittumisessa. Kuormittuminen liittyi työntekijöiden tulkintaan siitä, miten rasittaviksi asiakkaat koettiin. Työntekijöiden työtä ohjaava tieto oli hyvin erilaista ja työkulttuurien todettiin olevan ristiriitaisia. Silloin, kun vanhuksia kuvattiin avun tarpeen tai sairauden kautta, yhteyksiä muihin käsitejärjestelmän osiin oli vähän. Tällöin korostettiin harvoin asiakkaiden sosiaalisten suhteiden, elämän mielekkyyden, yksilöllisyyden tai sosiaalisen tuen merkitystä. Kun asiakkaita kuvattiin persoonallisten ja sosiaalisten tekijöiden avulla, käsitejärjestelmän osilla oli runsaasti yhteyksiä toisiinsa ja perushoito, sosiaaliset suhteet ja psyykkiset tekijät yhdistyivät kokonaisuudeksi. Stressin ja työtyytyväisyyden pääteltiin olevan erillisiä ilmiöitä, mutta niitä selittävillä tekijöillä on keskinäisiä yhteyksiä. Tutkimus antoi tukea oletuksille, että työn psykososiaalisilla tekijöillä ja erityisesti psyykkisellä stressillä on merkitystä tuki- ja liikuntaelinten oireiden esiintymisessä, ja että järjestämällä työ hyvin voidaan vaikuttaa fyysiseen kuormitukseen. Koska asiakkaisiin liittyvät stressitekijät osoittautuivat merkittäviksi stressitekijöiksi ja toisaalta käsitykset asiakkaista vaihtelivat voimakkaasti, saattaa työorientaatiolla olla yhteys myös työntekijöiden stressiin ja työssä viihtymiseen. Laitoshuollon kehittämisessä haastavammaksi ja vähemmän rasittavaksi olisi otettava huomioon työntekijöiden erilaiset tiedot ja erilaiset työorientaatiot. Jatkotutkimuksissa olisi siirryttävä pitkittäisasetelmien ja laajempien otosten käyttöön, jotta voidaan selvittää kausaalisuuden suuntaa toisaalta erilaisten organisaatioratkaisujen merkitystä

Work in care for the elderly. Combining theories of job design, stress, information processing and organizational cultures

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.This research set out to examine work and well-being of workers in elderly care from different theoretical perspectives. Work and problems were described, explanatory variables of stress and satisfaction discovered, relationships between stressors and job characteristics, relationships between patients' functional abilities, stressors, physical load, psychological stress symptoms and musculoskeletal symptoms explored. Also workers' knowledge about patients and cultural aspects were described. The data were gathered using a questionnaire survey of personnel, interviews of employees and measurements of patients' functional abilities in residential homes, health center hospitals and home care. The data were analyzed using the t-test, regression analysis and confirmatory factor analysis (LISREL). The concepts workers used to describe their clients were categorized and then quantified. Workers' use of categories were studied using correlations. Work in institutional care is demanding, in home care workers had less symptoms. In institutional care the most severe problems were ergonomic problems, time pressure, patient-related stressors, low skill utilization and autonomy, low levels of task identity and lack of feedback. Different stress symptoms and job satisfaction were explained by separate factors. Well-organized work was noticed to decrease time pressure and thereby physical load. The influence of psychosocial factors on musculoskeletal symptoms was, however, mediated by psychological stress symptoms. Patient characteristics also had effect on stress. Stress was related to workers' interpretation of how stressful patients were. Workers' knowledge was heterogenous and conflicting cultures occurred. When workers described patients as in need of help or as ill, relationships to other parts of the concept network were rare. Seldom emphasized were social, personal and psychological aspects. When patients were described using concepts relating to personal or social aspects, relationships between different parts of concept network were frequent. Stress and job satisfaction were concluded to be separate phenomenons, but the explanatory variables of them to be related. The results supported earlier findings about the relationships between psychosocial factors and musculoskeletal symptoms, and that by redesigning work physical load can be reduced. As the patient-related stressors were signified as important stressors and knowledge about patients differed strongly, work orientation may be related to stress and job satisfaction

The mediating effect of psychosocial factors in the relationship between self-organizing teams and employee wellbeing : A cross-sectional observational study

Background: Several benefits of working in a self-organizing team, such as higher job satisfaction and better en-gagement to work have been demonstrated in previous studies.Objective: To examine whether those employees working in a self-organizing team have higher job satisfaction and lower turnover intentions compared to those in non-self-organized teams. Further, to test whether psycho-social factors defined by the Job Demand-Control model would function as mediators.Design: A cross-sectional survey study.Setting(s): Home care and assisted living facilities (with 24-h assistance).Participants: Licensed practical nurses (N = 377), registered nurses, therapists and managers (N = 183), and other employees (N = 31) in services for older people.Methods: A survey for employees working in services for older people and who were either in the self-organized teams or in the non-self-organized teams. Data was analyzed using linear regression and mediation analyses.Results: Those employees who worked in a self-organizing team were more satisfied with their job and had lower turnover intentions compared to those in a non-self-organizing team (mean [SD] 3.9 [1.0] vs. 3.7 [1.0], p = 0.006 and 2.2 [1.2] vs. 2.5 [1.3], p = 0.006, respectively). Moreover, job demands and job strain partially mediated the effect of self-organizing teamwork on job satisfaction (Average causal mediation effect [95%CI] 0.09 [0.02-0.15] and 0.10 [0.03-0.18], respectively), as well as on turnover intentions (Average causal mediation effect [95%CI] -0.08 [-0.15 to -0.01] and -0.20 [-0.18 to-0.03], respectively).Conclusions: In the context of older people care services, working in self-organizing teams may enhance employee wellbeing by lowering job demands and job strain, but not by improving job control. Based on the findings of this study, self-organization seems beneficial, however, it requires real autonomy for the teams and team building.Tweetable abstract: Self-organizing teamwork increases job satisfaction and decreases turnover intentions via lower job demands and strain in older people care.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).Peer reviewe

Medical deserts in Finland: measuring the accessibility and availability of primary health care services

Abstract Background: Well-functioning primary health care (PHC) systems are needed to meet the challenges of aging populations and increasing care needs. However, “medical deserts”, areas with poor accessibility and availability of PHC services, remain a significant issue throughout Europe, contributing to regional inequalities. Identifying the location of these areas is crucial for effective policymaking and for improving health outcomes. Our aim was to locate underserved areas in Finland by developing a medical desert index. In addition, we examined the impact of telehealth, care needs, and multiple funding sources on the index and analyzed its association with key quality indicators. Methods: The index was calculated using routinely collected municipality-level PHC consultation data from 2022 adjusted for population care needs (availability) and the average travel time to the nearest PHC center (accessibility). Telehealth and occupational healthcare consultations were included separately. Standardized index values were mapped and categorized using descriptive analysis, and compared with indicators of healthcare utilization, care accessibility and availability, care satisfaction, and continuity of care using correlation analysis. Results: The index displayed clear patterns of medical deserts, primarily in the rural areas of northern and eastern Finland. Approximately 13% of the Finnish population resided in medical deserts, defined as a standard score of -0.5 or lower. The inclusion of telehealth consultations appeared to improve the index values especially in some rural areas. Better accessibility and availability of PHC services, as indicated through the index, was significantly correlated with lower proportion of acute care consultations, fewer hospital care days, and lower continuity of care among clients aged 65 years and older. Conclusions: We were able to identify medical deserts in Finland utilizing novel methodology distinct from previous indicators, and thus providing important considerations for future research on regional inequalities in accessibility and availability of PHC services. Our findings demonstrated the potential of telehealth services in mitigating medical deserts, though its appropriateness for some population groups and care needs remains unclear. We call for health policy addressing PHC service provision especially in rural areas.Abstract Background: Well-functioning primary health care (PHC) systems are needed to meet the challenges of aging populations and increasing care needs. However, “medical deserts”, areas with poor accessibility and availability of PHC services, remain a significant issue throughout Europe, contributing to regional inequalities. Identifying the location of these areas is crucial for effective policymaking and for improving health outcomes. Our aim was to locate underserved areas in Finland by developing a medical desert index. In addition, we examined the impact of telehealth, care needs, and multiple funding sources on the index and analyzed its association with key quality indicators. Methods: The index was calculated using routinely collected municipality-level PHC consultation data from 2022 adjusted for population care needs (availability) and the average travel time to the nearest PHC center (accessibility). Telehealth and occupational healthcare consultations were included separately. Standardized index values were mapped and categorized using descriptive analysis, and compared with indicators of healthcare utilization, care accessibility and availability, care satisfaction, and continuity of care using correlation analysis. Results: The index displayed clear patterns of medical deserts, primarily in the rural areas of northern and eastern Finland. Approximately 13% of the Finnish population resided in medical deserts, defined as a standard score of -0.5 or lower. The inclusion of telehealth consultations appeared to improve the index values especially in some rural areas. Better accessibility and availability of PHC services, as indicated through the index, was significantly correlated with lower proportion of acute care consultations, fewer hospital care days, and lower continuity of care among clients aged 65 years and older. Conclusions: We were able to identify medical deserts in Finland utilizing novel methodology distinct from previous indicators, and thus providing important considerations for future research on regional inequalities in accessibility and availability of PHC services. Our findings demonstrated the potential of telehealth services in mitigating medical deserts, though its appropriateness for some population groups and care needs remains unclear. We call for health policy addressing PHC service provision especially in rural areas