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: Substantial improvements in health and safety were seen following implementation of a participatory ergonomics program among hospital orderlies.
Abstract: Background:
High rates of work-related injuries are seen among health care workers involved in lifting and transferring patients. We studied the effects of a participatory worker–management ergonomics team among hospital orderlies.
Methods:
This prospective intervention trial examined work injuries and other outcomes before and after the intervention, with other hospital employees used as a concurrent control. All orderlies in a 1,200-bed urban hospital were studied using passively collected data (mean employment during study period 100–110 orderlies); 67 orderlies (preintervention) and 88 orderlies (postintervention) also completed a questionnaire. The intervention was the formation of a participatory ergonomics team with three orderlies, one supervisor, and technical advisors. This team designed and implemented changes in training and work practices.
Results:
The 2-year postintervention period was marked by decreased risks of work injury (RR = 0.50, 95% CI 0.35–0.72), lost time injury (RR = 0.26, 95% CI 0.14–0.48), and injury with three or more days of time loss (RR = 0.19, 95% CI 0.07–0.53). Total lost days declined from 136.2 to 23.0 annually per 100 full-time worker equivalents (FTE). Annual workers' compensation costs declined from $237/FTE to $139/FTE. The proportion of workers with musculoskeletal symptoms declined and there were statistically significant improvements in job satisfaction, perceived psychosocial stressors, and social support among the orderlies.
Conclusion:
Substantial improvements in health and safety were seen following implementation of a participatory ergonomics program. Am. J. Ind. Med. 35:358–365, 1999. © 1999 Wiley-Liss, Inc.
176 citations
Journal Article•
167 citations
"Intervention studies in the health ..." refers background in this paper
...Action research (6, 5, 7), as seen in workplace intervention studies, lends itself most readily to integration of the two paradigms in the same project (12)....
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...An example of this kind of evaluation is the study performed by Garg and Owen (6), where exposure was measured before and after work improvements....
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...Positive outcomes of physical exercise as workplace health promotion have also been demonstrated (6, 15, 37), s ee a ls o We st gaar d & Wi nkel ( 1999) f or a n exte nsi ve r evi ew of wor kpl ace int er vent ions agai nst mus cul oske let al pa in) ....
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...Various aspects of the project have been described in detail in a number of previous reports (4, 5, 6, 14, 15)....
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...Focusing on the individual, such interventions have been successful for relaxation training, stress seminars, and physical training (6, 37)....
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TL;DR: Back Injuries may be prevented by the teaching of patient-handling skills, and the difference between the trained and control groups was not statistically significant.
Abstract: The aim of this intervention was to evaluate the effect of training on patient-handling skills and prospectively to assess the effect of skill on subsequent back pain and back injuries in nursing. Of a total of 255 nurses, 199 were assessed for their skill in patient-handling. One-half (control group) received traditional training in patient-handling, and the other half (trained group) received a curriculum of instruction totaling 40 hours. The skills of both groups were assessed on graduation. The control group was rated as less competent in patient-handling. Nurses in both groups were questioned about the prevalence of back pain and incidence of back injuries in the first year after graduation. In multiple regression analysis, the major risk indicators for back injuries were poor patient-handling skill, low numbers of repetitions in the sit-up test, and high work-load scores. High score on the hysteria scale of Middlesex Hospital Questionnaire was a risk indicator for all kinds of back pain. Though back pain was independent of patient-handling skill, those rated as "bad" or "poor" had more back injuries (24%) than those who had been rated as "good" or "excellent" (2%) (P less than 0.001), but the difference between the trained and control groups was not statistically significant. It was concluded that back injuries may be prevented by the teaching of patient-handling skills.
166 citations
TL;DR: In this article, the authors discuss the opinions and interests of company management, the nature of psychology, the difficulty of conducting methodologically sound intervention studies and the denominational segregation of stress research.
Abstract: Stress prevention programmes are predominantly reactive and aimed at individuals. Four factors that may contribute to this current status are discussed: the opinions and interests of company management, the nature of psychology, the difficulty of conducting methodologically ‘sound’ intervention studies and the denominational segregation of stress research. To increase the impact of organizational level interventions, the effects need to be demonstrated on matters that appeal to company management, such as quality of products and services, organizational flexibility, productivity and sickness absence rates. The demonstration of examples of good preventive practice is considered as a conditio sine qua non for developing effective stress prevention procedures and for the involvement of both social partners in this field. Therefore, 10 Dutch projects from several branches of industry, aimed at the reduction of work stress, physical workload and sickness absenteeism, were selected, analysed and compared. The results show that in most cases sickness absenteeism was reduced and that the benefits exceeded the costs of the interventions. Five factors seem to be at the heart of a successful approach: (1) its stepwise and systematic nature, (2) an adequate diagnosis or risk analysis, (3) a combination of measures (i.e. both work-directed and person-directed), (4) a participative approach (i.e. worker involvement) and (5) top management support. In conclusion, the projects suggest that stress prevention may be beneficial to both the employee and the organization. © 1998 John Wiley & Sons, Ltd.
164 citations