Evaluation of an intervention programme based on empowerment for eldercare nursing staff

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.     

Organizational interventions: A research-based framework for the evaluation of both process and effects

Abstract

Organizational interventions are often recommended when organizations want to improve employee psychological health and well-being. Research, however, has revealed inconsistent results and reviewers have called for research on why interventions either bring about desired change or fail to do so. Answering the “how” and “why” of intervention outcomes requires a close examination of the elements that hinder or facilitate desired outcomes, thus moving beyond evaluation of only the overall effects. In this paper, we present an evaluation framework based on recent intervention research and process-oriented organization theory. The framework offers suggestions for which elements to include when evaluating organizational interventions. Within the framework, elements crucial to intervention evaluation are grouped into four overarching categories that we argue are crucial to evaluation over the five phases of an intervention programme. These categories are: the organizational “actors”; the mental models of those actors; the context of the intervention; and intervention design and process. Evaluation during the process as well as of the overall effects, as recommended by this framework, should throw light on what works for whom, why, how and under which circumstances.     

The health of health care organizations

Abstract

This paper explores the nature and development of health care organizations in terms of a model of organizational healthiness. The model places particular emphasis on the psychosocial subsystems which describe the subjective organization. These represent the perceived internal functioning of the organization in terms of task completion, problem solving and staff development. The implications of such a model for the well-being of health care staff and for the evaluation of service delivery are discussed.     

In sickness and in health: An exploration of spousal support and occupational similarity

Abstract

While many studies of interventions have focused on their content and immediate effects, less research has focused on the processes that may explain these effects. The purpose of this study was to show how process evaluation can be used to interpret the results of an intervention study in four industrial canteens in Denmark. Two canteens acted as intervention groups and two as comparison groups. Effects were measured by surveys before and after interventions, and observations and interviews were conducted to provide an in-depth understanding of processes. Analyses were conducted based on the responses from 118 employees. Results showed, contrary to expectations, improvements in working conditions and well-being in one intervention group and in one comparison group, whereas no improvements were found in the two remaining groups. Data from the process evaluation enabled a meaningful interpretation of these results, raising the possibility programme failure rather than theory failure, and thereby constituting an example of how process evaluation can shed light over the factors that may influence outcomes in controlled intervention studies.     

Organizational change,health, and sick leave among health care employees: A longitudinal study measuring stress markers,individual, and work site factors

Abstract

This controlled longitudinal study was conducted to investigate the effects of organizational change on employees’ self-reported health, work satisfaction, work-related exhaustion, stress, and sick leave. The population consisted of 226 employees at T1 and 198 at T2, divided into a study group affected by organizational changes, and a reference group not affected by them. Group differences for the outcome measures self-rated health (SRH), work satisfaction, work-related exhaustion, and hormones associated with stress were analysed using a two-factor ANOVA design for repeated measurements. Our findings showed no significant differences, either across time or between groups for SRH, work satisfaction, and work-related exhaustion. However, we did find significant change across time and between groups for the recovery hormone DHEA-S. Days of sick leave increased by 7% for employees in the study group and by 2% in the reference group. Serum cortisol showed significantly decreased levels across time but not between groups. The decreased recovery potential in the study group might have long-term health implications. The study points to the importance of looking at the impact of organizational change on employee well-being from a number of perspectives, such as self-reported health parameters, registered sick-leave data, and biological stress markers.     

Effects of vacation from work on health and well-being: Lots of fun,quickly gone

Abstract

Although vacation from work provides a valuable opportunity for recovery, few studies have met the requirements for assessing its effects. These include taking measurements well ahead of the vacation, during the vacation and at several points in time afterwards. Our study on vacation (after-) effects focused on two related questions: (1) Do health and well-being of working individuals improve during a vacation? and (2) How long does a vacation effect last after resumption of work? In a longitudinal study covering seven weeks, 96 Dutch workers reported their health and well-being levels two weeks before a winter sports vacation, during vacation and one week, two weeks and four weeks after vacation on seven indicators. Participants' health and well-being improved during vacation on five indicators: health status, mood, tension, energy level and satisfaction. However, during the first week of work resumption, health and well-being had generally returned to pre-vacation levels. In conclusion, a winter sports vacation is associated with improvements in self-reported health and well-being among working individuals. However, these effects fade out rapidly after work resumption. We propose a framework for future vacation research and suggest investigating the role of vacation type, duration and means to prolong vacation relief.     

The relationship between perceived employability and subsequent health

Abstract

Being capable of getting new employment may enable an employee to cope with turbulent situations or deteriorating job conditions. Individuals who have higher perceived employability are likely to appraise a situation at work more favourably, and consequently experience better health and well-being. The aim of the present study was to investigate the relationship between perceived employability and subsequent health, while controlling for baseline health, background factors, and work environment exposures. The study is based on 53 items in the National Working Life Cohort in Sweden from two data collections (2004 and 2005), comprising 1918 individuals. Forced entry hierarchical regression analysis showed that, after controlling for demographics, psychological demands, control, and ergonomic exposures, perceived employability was positively associated with global health and mental well-being, but unrelated to physical complaints. When baseline health status was added, perceived employability was still a significant predictor of two out of three outcome variables. Individuals with higher perceived employability had a tendency to report better health and well-being a year later. It is concluded that how an employee perceives his or her possibilities in regard to acquiring new employment is relevant for well-being at a later stage. Perceived employability, which has been little studied before, is therefore a useful concept in health promotion, both at the individual and at the organizational level.     

Beyond demand and control: The contribution of organizational risk factors in assessing the psychological well-being of health care employees

Abstract

The job demand–control(–support) model is frequently used as a theoretical framework in studies on determinants of psychological well-being. Consequently, these studies are confined to the impact of job characteristics on worker outcomes. In the present study the relation between work conditions and outcomes (job satisfaction, emotional exhaustion, psychological distress, and somatic complaints) is examined from a broader organizational perspective. This paper reports on an analysis that examines both the unique and the additional contribution of organizational characteristics to well-being indicators, beyond those attributed to job characteristics. A total of 706 care staff from three public residential institutions for people with mental or physical disabilities in the Netherlands took part in this research. To assess organizational risk factors a measurement instrument was developed, the organizational Risk Factors Questionnaire (ORFQ), based on the safety-critical factors of the Tripod accident causation model. Factor analyses and reliability testing resulted in a 52-item scale consisting of six reliable sub-scales: staffing resources, communication, social hindrance, training opportunities, job skills, and material resources. These organizational risk factors explained important parts of the variance in each of the outcome measures, beyond that accounted for by demographic variables and job demand–control–support (JDCS) measures. Communication and training opportunities were of central importance to carers’ job satisfaction. Social hindrance, job skills, and material resources explained a substantial amount of unique variance on the negative outcomes investigated.     

Exploration of the impact of organisational context on a workplace safety and health intervention

ABSTRACT

The Safety and Health Improvement Program (SHIP) was designed to increase workers’ safety and health using supervisor/leadership training. SHIP was implemented and evaluated in a cluster randomized controlled trial with 20 supervisors and 292 construction crew members representing a high-risk industry. The intervention had three components: (1) computer-based training to teach supervisors ways to better support worker safety and work-life challenges; (2) supervisor behavioural self-monitoring to facilitate transfer of training to practice; and (3) team-based discussions with supervisors and work crew members to identify challenges and opportunities for improvement with 30, 60, and 90 day follow-up check-in meetings. Main effects for the intervention on perceptions of family supportive supervisor behaviors, team effectiveness, and work-life effectiveness were not found, suggesting that the pre-intervention context could help explain the lack of intervention effects. We found that the intervention was more beneficial for work crew members who had poorer pre-intervention perceptions of their supervisor (lower leader-member exchange) and lower perceived team cohesion, suggesting the important impact of the organisational context on intervention effects. We argue that perhaps these work crews were more ready for change and improvements in functioning than were the crews that were already functioning well.     

Employees' perceptions of organizational restructuring: The role of social support

Organizational change and restructuring is often perceived as leading to increased occupational stress, impacting negatively on the psychological well-being of employees. This pragmatic study investigates the role of social support and dispositional affect as moderators of role stress post-restructuring for employees in a public utility company. A total of 176 employees, including 37 managers, 60 graded staff and 78 industrial staff completed a self-report questionnaire, approximately 1 year postrestructuring, retrospectively assessing role conflict, ambiguity, overload and positive and negative feedback pre- and post-restructuring. Results suggested that overall role stress increased for managers/ senior officers and graded staff, but not for industrial staff. Social support was linked with lower role stress, more positive feedback and less negative feedback at post-restructuring. For certain role stressors this impact was moderated by dispositional affect, but the effect was not consistent across occupational groups. Positive affect enhanced the effect of manager support in reducing role conflict for graded staff, and the effect of co-worker support in increasing positive feedback and reducing negative feedback for industrial staff. Findings suggest that managers should pay particular attention to support and feedback for employees during periods of chronic occupational stress following organizational restructuring.     

Personality and organizational health: the role of conscientiousness

Organizational health research identifies processes through which the work environment and individual differences combine to influence both individual and organizational outcomes. This study investigated the contribution of conscientiousness to organizational health. Research in the areas of occupational stress, work performance, and organizational climate was used to develop a framework for integrating different elements of organizational health. Within this framework, the work environment was assessed by perceptions of workload and role clarity ; individual well-being was assessed by psychological distress and job satisfaction ; and behaviour important for organizational success was assessed by contextual performance. Conscientiousness was investigated within the framework using self-reports from a sample of 104 Australian employees. Conscientiousness directly influenced contextual performance but did not influence well-being or perceptions of the work environment. Conscientiousness also reduced the impact of role clarity on both psychological distress and job satisfaction. The role of conscientiousness in a comprehensive model of organizational health is discussed.     

Violence in the nursing profession: Occupational and lifestyle risk factors in Swedish nurses

Abstract

In a national study of the work environment, physical, and mental well-being of more than 2600 Swedish nurses, 30% reported having experienced violence at work. Possible association between violence and a range of occupational, demographic, and lifestyle characteristics were studied. Stepwise multiple linear and logistic regressions were used to further examine risk factors for violence. Occupational factors with significant correlations to workplace violence were nursing discipline (type of ward or facility), years of work experience, supervisory responsibilities, night work, work dissatisfaction, work-related musculoskeletal injury, and frequency of patient handling. Demographic/lifestyle factors related to violence were age, gender, smoking, coffee consumption at work, and use of alcohol to relax after work. The best fit linear regression model explained 17% of the variance in violence, 13%, of the variance in threat of violence. The logistic regression model confirmed an increased risk of violence and threats in psychiatric and geriatric settings. However, much remains unexplained about the aetiology of violencc in health carc settings. This report provides the basis for a pilot intervention study currently in progress.     

Using a stress audit: The construction site manager experience in the UK

Abstract

The aim of this study was to conduct a stress audit among construction industry site managers in the UK as a precursor to a stress management intervention programme. Qualitative data were obtained from in-dept interviews with a total of 36 male middle and senior construction site managers; and aquantitative data were obtained by questionnaire. Based on the analysis of 561 postal quenstionnaires, eight stressor factors were identified, most significantly, ambiguity (i.e. role and task). Job satisfaction levels were low compared to a normative population and influenced by grade level. Measures of mental health were similar to the norm for males, but both grade of management and type of contract affected mental health. Anxiety levels were signficantly high, independent of managerial grade. The stress of work overload and role insecurity (fear of failure) were associated with reduced mental health and high anxiety, and the stress of the organizational culture and climate was the strongest predictor of job dissatisfaction. There was some cause for concern for the vulnerable high-risk groups, i.e. the extreme type A and those working overtime. Medical data from a small subset of managers (n = 78) revealed that this group evidenced a better quality of psychological health than the group in total; but a high percentage of personnel had high levels of triglycerides and cholesterol. Recommendations for action focused on the needs of specific subgroups, and guided the organization on the acceptability of possible interventions at individual, interpersonal and organizational levels.     

Well-being and organizational performance: An organizational-level test of the happy-productive worker hypothesis

Abstract

It is often assumed that happy workers are also productive workers. Although this reasoning has frequently been supported at the individual level, it is still unclear what these findings imply for organizational performance. Controlling for relevant work characteristics, this study presents a large-scale organizational-level test of the happy-productive worker hypothesis, assuming that high individual well-being leads to high individual-level performance, which should translate into high organizational performance (such as high efficiency and productivity). Job-specific employee well-being was measured as job satisfaction and emotional exhaustion. Using data from 66 Dutch home care organizations, the relationships among aggregated levels of demands, control, support, emotional exhaustion and satisfaction on the one hand, and organizational performance on the other, were examined using regression analysis. The hypotheses were partly confirmed, especially high aggregated levels of emotional exhaustion were related to low organizational performance. Although these findings support the reasoning that happy organizations are indeed productive organizations, more theorizing and more longitudinal research on the associations between individual-level well-being and organizational performance is imperative to improve understanding of these relationships. The findings underline the importance of improving worker well-being: this is not only important for individual workers, but may also have positive consequences for organizations and their clients.     

Pregnancy,work and women's well-being: A review

Abstract

Pregnancy is potentially a stressful period for working women for ergonomic, psychological and organizational reasons, yet the well-being of women is seldom the focus of research on working during pregnancy. This paper reviews the literature on women's experience of being pregnant at work. It concludes that, while working conditions are usually not well suited to pregnant women, the majority of women encounter only minor difficulties and regard working in a positive way. However, for a minority of women working during pregnancy adversely affects their well-being. These are likely to be women working during pregnancy adversely affects their well-being. These are likely to be women who are most at risk from work-related stress at other times. The literature suggests that working during pregnancy has still to be accepted and accommodated by employers and colleagues.     

The downside of organizational identification: Relations between identification,workaholism and well-being

Abstract

Employee organizational identification has been proposed and found to be positively related to employee health and well-being. The empirical evidence, however, is not unequivocal, and some authors have suggested possible downsides of identification with the organization as a whole or with a group within it. The potential negative effect of over-identification was tested empirically for the first time in the present paper. Two studies were conducted; Study 1 was cross-sectional and used a sample of Italian law court clerks (N=195) and Study 2 was longitudinal and employed a sample of Italian teachers (N=140 at T2). We proposed a curvilinear mediation model with identification curvilinearly predicting workaholism, and workaholism, in turn, negatively affecting employee well-being. This curvilinear link between organizational identification and workaholism means that workaholism at first decreases with growing identification, but when identification becomes too strong, workaholism increases. The results confirmed our hypotheses, and we discuss theoretical and practical implications.     

A process evaluation of individual and organizational occupational stress and health interventions

There is reason to believe that many health and stress interventions fail due to inattention to the effects of intervention implementation processes, but evaluations of these processes are found only rarely in the literature. The objective of the present study was to explore the issue of obstacles to implementation that may occur when stress and health interventions are introduced in work organizations. The study was conducted as a process evaluation of seven different individual and organizational interventions. Interviews were conducted in 22 post offices, 12 organizational units (such as care homes and local administrative units) of a Norwegian municipality, and in 10 shops in a shopping mall. The interviews took place before and after the interventions. The following key process factors were identified: (1) the ability to learn from failure and to motivate participants; (2) multi-level participation and negotiation, and differences in organizational perception; (3) insight into tacit and informal organizational behaviour; (4) clarification of roles and responsibilities, especially the role of middle management; and (5) competing projects and reorganization. For improved studies of interventions in the future we recommend that qualitative and quantitative methods be combined, that researchers build more on natural interventions that occur naturally within the organization, and that a pilot study be undertaken in order to investigate the cultural maturity of the organization.     

Work satisfaction,health, and stress: A study of Dutch nurses

Abstract

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.     

Work-self balance: A longitudinal study on the effects of job demands and resources on personal functioning in Japanese working parents

Abstract

In work-family research the effects on the individual, or the “self”, in terms of personal interests independent of the work and family domains, have been largely neglected. This longitudinal study on 471 Japanese employees with young children investigated how job demands and job resources may have an impact on well-being by facilitating or hindering personal functioning. It was hypothesized that workload would have an unfavourable impact on work-to-self conflict, while supervisor support would have a favourable impact on work-to-self facilitation. In addition, we hypothesized that work–self conflict would diminish well-being (psychological distress and happiness), while work–self facilitation would enhance well-being over time. Structural equation modelling analyses using a full panel design showed that work overload was positively related to work–self conflict over time, whereas supervisor support was positively related to work–self facilitation. Furthermore, work–self conflict predicted psychological distress and happiness at T2, one year later, after controlling for T1 levels. These findings suggest that the demands and resources encountered at work can spill over to the home domain and have an impact on personal functioning and context-free well-being. Further research is needed to determine the importance of work-self constructs in relation to work-family constructs.     

Organizational-level interventions to reduce occupational stressors

Abstract

Occupational stress research continues to grow, and is increasingly being used to inform national policy on worker health and well-being. Most models of occupational stress emphasize notions of person-environment fit. Two approaches for intervention to minimize adverse consequences of occupational stress follow from such models. One emphasizes the strengthening and enhancement of indwiduals and their resources, the other emphasizes the reduction ofcommon workplace-based sources ofoccupational stress. This paper reviews 10 organizational-level interventions to reduce stress at work which have been examined in various field studies. These interventions were generally found to have positive effects, and, given the limited success of individual-level interventions in addressing occupational sources of stress, should be encouraged.