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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Journal Article•
TL;DR: Although many methodological issues associated with field-based research are not easily addressed, researchers should make a stronger attempt to address these issues if the field of occupational health and safety intervention research is to be productive.
Abstract: This paper reviews occupational health and safety intervention studies published between 1988 and 1993 to gauge the nature and extent of research in this area. Generally, the studies often lacked a theoretical basis, used small samples, and tested interventions lacking the intensity to cause the desired change. Most designs were either nonexperimental or quasi-experimental with uncontrolled sources of bias. Recommendations for future research include methods of minimizing the problems and biases caused by these weaknesses. Nonmethodological issues such as the costs of implementing interventions and the cultural and political dimensions of the workplace are also addressed. Although many methodological issues associated with field-based research are not easily addressed, researchers should make a stronger attempt to address these issues if the field of occupational health and safety intervention research is to be productive. Language: en
135 citations
"Intervention studies in the health ..." refers background in this paper
...Geurts & Grundemann (1999) distinguished between (1) worker- versus work-oriented interventions and (2) primary versus secondary/tertiary interventions....
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...Aiken and Sloane (2) and Aiken et al (3) also found...
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...Qualitative research methods can address the important issues of how to initialize and implement interventions in health care (2, 3)....
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TL;DR: It is argued that a moderately varied flow of stimuli and events, opportunities to engage in psychologically meaningful work, and to exercise personal control over situational factors, may be considered key components in the quality-of-life concept.
Abstract: This paper considers the quality-of-life concept from the point of view of harmony between fundamental human needs and environmental conditions. It is argued that the knowledge gained by research in psychobiology can aid in directing technological applications to suit human needs and abilities. Examples are given from a multidisciplinary research program concerned with the dynamics of stressful person-environment transactions, viewed from psychological and biological perspectives. Emphasis is placed on coping and adaptation in workers exposed to conditions characterized by underload, overload, and lack of control. On the basis of empirical results, it is argued that a moderately varied flow of stimuli and events, opportunities to engage in psychologically meaningful work, and to exercise personal control over situational factors, may be considered key components in the quality-of life concept.
132 citations
TL;DR: The findings are consistent with previous reports linking LBP with manual materials handling and driving at work, however, in this sample, less than 20% of the cases could be attributed to such activities.
Abstract: Associations between occupational activities and low-back pain (LBP) were examined in a retrospective postal survey of 545 randomly selected adults. Each subject gave a lifetime occupational history on six specified physical activities and also a lifetime history of LBP. Among the 436 subjects answering the questionnaire, the lifetime incidence of LBP was 63%. The occurrence of LBP was related by Cox's proportional hazards regression model to occupational activities in the year prior to the onset of symptoms. For the men the strongest associations were with heavy lifting and prolonged car driving. There was also an association with heavy lifting among the women. These risks were exaggerated in the subset of subjects whose LBP followed a chronic unremitting course. The findings are consistent with previous reports linking LBP with manual materials handling and driving at work. However, in this sample, less than 20% of the cases could be attributed to such activities.
131 citations
TL;DR: This programme reduced the incidence and time lost due to back injuries and was cost-beneficial, as the increased assessment and treatment costs per case attributable to the programme were more than offset by the savings in lower compensation (wage loss) costs.
Abstract: This study evaluated a two-year multidisciplinary early intervention pilot programme for back-injured nurses employed at a large teaching hospital, using a pre- versus post-programme analysis. The purpose was to ascertain whether this programme could reduce the incidence, morbidity, time lost and cost due to back injuries in the 250 nurses employed on ten targeted high-risk wards. Injuries in the remaining 1395 nurses employed on the other 45 wards were monitored concurrently for comparison. The programme consisted of prompt assessment, treatment and rehabilitation through modified work. Evaluative data were gathered by one research nurse on standardized forms at the time of injury, weekly until return to work, and at a six-month follow-up. Time lost and cost data for up to one-year post-injury were derived from workers' compensation statements. Compared to the two years prior to introduction of the programme, the rates of back injuries and lost-time back injuries decreased by 23% and 43%, respectively, on the targeted wards, while these increased on the control wards. Combined expenditure was 32% lower per injury and 34% lower per lost-time injury for those in the targeted group who consented to take part in the programme compared to their counterparts on the control wards, as the increased assessment and treatment costs per case attributable to the programme were more than offset by the savings in lower compensation (wage loss) costs. This programme thus reduced the incidence and time lost due to back injuries and was cost-beneficial.
130 citations