Intervention studies in the health care work environment : Lessons learned
01 Jan 2000-
TL;DR: Five different methods of integration are proposed: a qualitative approach as a foundation for the design of a quantitative study, qualitative studies to gain deeper insight and better analyses of the results from a qualitative study, quantitative research to study frequencies and distributions of phenomena discovered by qualitative approaches, parallel and integrated use of qualitative and quantitative approaches, and quantifying qualitative data.
Abstract: The old controversy between qualitative and quantitative approaches to the study of workplace stressors and workers ́ health may be bypassed by looking at them as complementary to each other. Especially, intervention research would profit from the integrated use of both approaches when it comes to validity and reliability of the data. This applies to assessment of both the work and health related problems as well as the effects of the intervention. Also quite practical issues must be considered, such as the question of status for the two approaches within the research group, the possibility to integrate the two methods, not only conduct them in separate and parallel processes, and the sequencing of the approaches. Five different methods of integration are proposed: 1) a qualitative approach as a foundation for the design of a quantitative study, 2) qualitative studies to gain deeper insight and better analyses of the results from a quantitative study, 3) quantitative research to study frequencies and distributions of phenomena discovered by qualitative approaches, 4) parallel and integrated use of qualitative and quantitative approaches, and 5) quantifying qualitative data.
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TL;DR: The Practice Environment Scale–Nursing Work Index (PES–NWI) seems to be one of the most promising instruments because of its appropriateness, its structure, which has a rather good fit, and its ability to discriminate magnet hospitals like other NWI derivates (discriminant validity).
Abstract: This systematic review assesses the validity of epidemiological questionnaires used to measure psychosocial and organizational work factors (POWFs) in nurses Of the 632 articles published between 1980 and July 2008 identified in this review, 108 provide some data concerning analysis of the intrinsic characteristics of such instruments (content validity or conceptual basis, reliability, validation of internal construction) and their external validity with respect to health aspects (concurrent validity and predictive validity) Psychometric properties of generalist questionnaires validated among blue collar or white collar workers were also assessed in the nurse population The Job Content Questionnaire (JCQ), because of its longevity and reputation, was the generalist questionnaire most used among this population Although its structure often raises questions in the nurse population, its dimensions (mainly the control one) have been shown to be predictive of some health outcomes measured with "objective" indicators concerning absenteeism, injuries, and musculoskeletal disorders Effort Reward Imbalance (ERI), which has a structure more stable among the nurse population, has shown concurrent validity in terms of intent to leave the nursing profession No questionnaire specifically designed for nurses can claim to satisfy all of the recommendations in terms of internal validity Nevertheless, the Practice Environment Scale-Nursing Work Index (PES-NWI) seems to be one of the most promising instruments because of its appropriateness (content validity), its structure, which has a rather good fit (construct validity), its ability to discriminate magnet hospitals like other NWI derivates (discriminant validity), and it has also been associated in cross-sectional studies with health outcomes, especially nurses' self-assessed mental health but also with patients' health outcomes objectively assessed (concurrent validity) However, elements for predictive validity are still lacking with NWI derivates The Discussion provides recommendations for measuring POWFs, encompassing the use of external validated measurements
70 citations
Cites methods from "Intervention studies in the health ..."
...Recommendations for measuring change in psychosocial working conditions (Smith & Beaton, 2008) and for interventions aimed at reducing adverse POWFs in health care establishments have been published (Cox, Randall, & Griffiths, 2002; Mykletun et al., 2000)....
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TL;DR: The (lack of) stability in units of analysis in occupational health and safety intervention projects directed toward worksites is described to raise serious questions concerning design, analyses and interpretation of results.
Abstract: Interventions in occupational health often target worksites rather than individuals. The objective of this paper is to describe the (lack of) stability in units of analysis in occupational health and safety intervention projects directed toward worksites. A case study approach is used to describe naturally occurring organizational changes in four, large, Nordic intervention projects that ran 3–5 years, covered 3–52 worksites, cost 0.25 mill–2.2 mill €, and involved 3–7 researchers. In all four cases, high rates of closing, merging, moving, downsizing or restructuring was observed, and in all four cases at least one company/worksite experienced two or more re-organizations during the project period. If individual worksites remained, ownership or (for publicly owned) administrative or legal base often shifted. Forthcoming closure led employees and managers to seek employment at other worksites participating in the studies. Key employees involved in the intervention process often changed. Major changes were the rule rather than the exception. Frequent fundamental changes at worksites need to be taken into account when planning intervention studies and raises serious questions concerning design, analyses and interpretation of results. The frequent changes may also have deleterious implications for the potential effectiveness of many real life interventions directed toward worksites. We urge researchers and editors to prioritize this subject in order to improve the quality of future intervention research and preventive action.
46 citations
Cites background from "Intervention studies in the health ..."
...During 1997–99 the Nordic Council of Ministers sponsored a series of meetings of occupational intervention researchers to develop intervention research in the Nordic countries [4]....
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TL;DR: The results of the analyses with time lag (longitudinal) did not support the hypothesis that psychosocial and physical strain from 1 day of work predicts pain onset the following day, but physical exertion, stress, and, to some extent, time pressure were associated with pain on the day of onset.
Abstract: Objectives The aim of this study was to investigate psychosocial factors and physical exertion at work in relation to the onset of low-back pain.
Methods The study was carried out as a case-crossover investigation of nursing aides caring for the elderly. Cases were identified among 157 nursing aides over a period of 2 years. Psychosocial factors, physical exertion, and low-back pain were reported daily in diary questionnaires over three consecutive days at work, repeated in six periods of 3 days. For each subject, case observations were identified as pain onset from one day to the next and matched with reference observations with no pain onset from the same person. Prospective data collection allowed analyses to be conducted with and without a lag in time between exposure and pain onset.
Results The results of the analyses with time lag (longitudinal) did not support the hypothesis that psychosocial and physical strain from 1 day of work predicts pain onset the following day. However, physical exertion, stress, and, to some extent, time pressure were associated with pain on the day of onset.
Conclusion The effect period, if any, of exposure to physical exertion, stress, and time pressure on the onset of acute low-back pain is considered to be less than 24 hours.
43 citations
TL;DR: The NWI-EO is a useful tool for assessing POWFs among RNs and NAs in order to determine priorities for preventive action to improve work organisation at the unit level and was found to have good psychometric properties.
29 citations
01 Jun 2005
TL;DR: The results showed that the experience of workload, ergonomic troubles, psychosocial troubles and work stress had decreased at the same time as theExperience of stimulation and of joy at work had increased.
Abstract: A work environment intervention to test a model of age related workload was carried out at a local hospital. The staff received training about life course, work and work ability. Efforts at making changes in the work place were encouraged. Action plans were to be presented and the participating wards were given a grant in relation to the existing age structure, to carry out changes and to recruit younger persons. The results showed that the experience of workload, ergonomic troubles, psychosocial troubles and work stress had decreased at the same time as the experience of stimulation and of joy at work had increased. It was not possible to see any reduction in the HR costs or change in the working time and sick leaves. The action plans showed limited suggestions of changes. The organization's complexity and the traditional hierarchy of hospitals do not stimulate change, but the supervisors' involvement is also critical to the result of the staff's work. Work environment interventions are complicated and complex and influenced by many factors. One year is a very short time for an intervention. The importance of the experience of the staff of an improved work environment is however not to be diminished.
11 citations
References
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TL;DR: A review of worksite stress management studies can be found in this article, where the authors evaluate the merits of occupational stress management and compare them along dimensions of type of work group, orientation and format, stress management methods, non-specific effects, and long-term maintenance of skills and benefits.
Abstract: Published and unpublished studies evaluating the merits of occupational stress management are reviewed. Worksite stress management studies are compared along dimensions of type of work group, programme orientation and format, stress management methods, non-specific effects, and long-term maintenance of skills and benefits. Although studies differ widely on these dimensions and too few studies have been conducted to state unequivocally general conclusions, worksite stress management programmes appear to offer promise for helping workers cope with stress and exert greater control over physiological and psychological systems which are reactive to stressors. Troublesome issues in this young research area are noted and future research needs are enumerated. Finally, the advantages and potential disadvantages of worksite stress management programmes are described.
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TL;DR: The results suggest that a secondary prevention program aimed at altering life style factors may represent an effective method for dealing with musculoskeletal pain problems.
Abstract: The current investigation studied the effectiveness of a secondary prevention program for nurses with back pain who were deemed at risk for developing a chronic problem. A 2 X 3 repeated measures design was employed with 2 groups and 3 assessment periods. The treatment group received an intervention designed to reduce current problems, but above all to prevent reinjury and minor pains from becoming chronic medical problems, and it included a physical and behavioral therapy package. The control group was placed on a waiting-list. Results indicated that the treatment group had significantly greater improvements than the control group for pain intensity, anxiety, sleep quality and fatigue ratings, observed pain behavior, activities, mood, and helplessness. These differences were generally maintained at the 6 month follow-up. In addition, the treatment group broke a trend for increasing amounts of pain-related absenteeism, while the control group did not. Taken as a whole, the results suggest that a secondary prevention program aimed at altering life style factors may represent an effective method for dealing with musculoskeletal pain problems.
205 citations
TL;DR: The personnel at a geriatric hospital were randomized into two groups and one group was allowed to exercise during working hours to improve back muscle strength, endurance, and coordination and the other group did not participate in the exercise program and received no further advice or information.
Abstract: The personnel at a geriatric hospital were randomized into two groups. One group was allowed to exercise during working hours to improve back muscle strength, endurance, and coordination. The other group did not participate in the exercise program and received no further advice or information. After 13 months, the training group had increased back muscle strength. One subject had been absent from work 28 days in the training group whereas 12 subjects had been absent 155 days from work because of low back pain in the control group (P < 0.004). The back pain complaints and intensity of back pain in the training group also decreased in a statistically significant way. Every hour spent by the physiotherapist on the training group reduced the work absence among the participants by 1.3 days, resulting in a cost/benefit ratio greater than 10.
198 citations
TL;DR: There has been a dramatic decrease in the number of HBV infections among HCWs who are now at lower risk ofHBV infection than the general US population, and efforts need to be made to improve this coverage.
Abstract: Background: Hepatitis B virus (HBV) infection is a wellrecognized occupational risk for health care workers (HCWs). Vaccination coverage, disease trends, and the need for booster doses after hepatitis B vaccination of adults have been the subject of intense study during the 15 years of the vaccine's availability. Methods: Vaccination coverage of HCWs was determined from a review of medical records on a sample of employees from 113 randomly selected hospitals. The number of HBV infections among HCWs and the general US population for 1983 through 1995 was estimated from national surveillance data. Studies on long-term protection after hepatitis B vaccination of adults were reviewed. Results: A total of 2837 employee medical records were reviewed; 2532 employees (90%) were eligible to receive hepatitis B vaccine, and 66.5% of them (95% confidence interval, 61.9%-70.9%) had received 3 doses of hepatitis B vaccine. Vaccination coverage was highest (75%) for personnel with frequent exposure to infectious body fluids (phlebotomists, laboratory personnel, and nursing staff) and lowest (45%) for employees at low risk for exposure (dietary and clerical staff). The number of HBV infections among HCWs declined from 17 000 in 1983 to 400 in 1995. The 95% decline in incidence observed among HCWs is 1.5-fold greater than the reduction in incidence in the general US population. Studies on long-term protection demonstrate that vaccineinduced protection persists at least 1 years even when titers of antibody to hepatitis B surface antigen decline below detectable levels. Conclusions: Although a high percentage of HCWs have been fully vaccinated with hepatitis B vaccine, efforts need to be made to improve this coverage. There has been a dramatic decrease in the number of HBV infections among HCWs who are now at lower risk of HBV infection than the general US population. Vaccine-induced protection persists at least 11 years and booster doses are not needed at this time for adults who have responded to vaccination. Arch Intern Med. 1997;157:2601-2605
196 citations