Managing Risk in Community Care of Older People: Perspectives from the Frontline

Abstract

Since the mid-1980s, Australian governments have focused on expanding community and home-based services for older people. This has led to increased levels of dependency, vulnerability, and complexity to be managed in the community. Consequently, aged care services have had to develop mechanisms for regulating and managing these increased risks, and risk management has become more central to the practices of professional workers in this field. This paper reports on some findings from a large-scale study that explores the way risk management policies have been translated into practice by community-based services in Victoria, Australia. Drawing on interviews with 18 frontline and management professionals employed in community aged care, we found that these workers were wrestling with a diverse and new range of institutional risks beyond those encountered in the actual delivery of frontline care. We found that these workers experienced “risk” in four different contexts, which often created demands for contradictory or conflicting responses. Here we examine these “contexts of risk practice”: professional workers' relationships with their clients, relationships with other service providers, the unregulated nature of the home as a work environment, and community expectations about the management of risk. Despite tensions that frequently arose, workers expressed strong professional commitments to their clients and were motivated to find positive resolutions amid competing interests. We conclude that tensions experienced by workers were embedded in the structural dimensions of institutional relationships and the systematic absence of shared understandings of “acceptable” risks in the community care of older people, rather than in the failure of professional agency.     

Cognitive structure of occupational risks represented by a perceptual map

The main focus of risk management is technical and rational analysis about the operational risks and by those imposed by the occupational environment. In this work one seeks to contribute to the risk perception study and to better comprehend how a group of occupational safety students assesses a set of activities and environmental agents. In this way it was used theory sustained by psychometric paradigm and multivariate analysis tools, mainly multidimensional scaling, generalized Procrustes analysis and facets theory, in order to construct the perceptual map of occupational risks. The results obtained showed that the essential characteristics of risks, which were initially splited in 4 facets were detected and maintained in the perceptual map. It was not possible to reveal the cognitive structure of the group, because the variability of the students was too high. Differences among the risks analyzed could not be detected as well in the perceptual map of the group.     

How are nurses at risk?

The effectiveness of occupational health and safety management systems (OHSMS) can be understood through analysis of surveys such as the experiences of exposure to occupational hazards by Australian nursing occupations. How effectively OHSMS are implemented in the Australian health industry is unclear as few studies describe current hazard exposure patterns or the impact of OHSMS in the Australian health industry. This paper concludes from the analysis of an Exposure Survey of Australian nursing occupations that nursing occupations perceive themselves to be "at risk" of injury and/or management of OHS risk in work duties is affected by the patterns of hazard exposure, occupation group as well as employee attributes, perceptions, patterns and situations of work. The results highlight the top-rated hazards and imply that the perceptions of hazards in the workplace are different to actual risk experience (e.g. injury patterns). There is an unacceptable level of exposure to diverse hazards in Australian nursing occupations workplaces in regard to regulatory and performance obligations. Stronger strategies to achieve more effective risk treatment, integrate with hospital accreditation and quality programs are discussed to benefit system performance and the welfare of those in nursing occupations.     

Mental Health Workers Negotiating Risk on the Frontline

Abstract

Following deinstitutionalisation and the shift to models of community care, mental health practice has become increasingly focused on managing the risks posed by service users. However, the effects of risk management on workers’ professional identities have not been investigated empirically in Australia. Drawing on in-depth interviews with mental health workers from Victoria, Australia, this paper explores the diverse ways in which these workers adapted the formal technologies of risk management (e.g., the completion of risk assessment screens) to their professional identities. Some workers experienced risk management technologies as constraining their interventions with clients, while others saw these technologies as providing opportunities to strengthen and enhance their professional skills. Pondering these differences, the author speculates on the emergence of a new form of professional identity in the broader context of contemporary community mental health care.     

The influence of flexible management practices on the sharing of experiential knowledge in the workplace: a case study of food service helpers

Previous studies have shown that the job knowledge and prudent knowledge of experienced workers constitute a wealth that needs to be shared in workplaces to promote worker integration, job retention and occupational health and safety. It appears, however, that certain management practices undermine this knowledge sharing process. This case study of food service helpers in institutional food service departments is part of a research project aimed at comparing the impact of different work organization methods on knowledge sharing in the workplace on the basis of case studies carried out in several organizations. The results of this case study reveal that by destabilizing and weakening the work teams, flexible management practices create an environment that is not conducive to experiential knowledge sharing.     

A toolkit for MSDs prevention--WHO and IEA context

Many simple MSD risk management tools have been developed by ergonomists for use by workers and employers with little or no training to undertake injury prevention programs in their workplace. However, currently there is no "toolkit" which places such tools within an holistic, participative ergonomics framework and provides guidance on how best to use individual tools. It is proposed that such an holistic approach should entail initial analysis and evaluation of underlying systems of work and related health and performance indicators, prior to focusing in assessment of MSD risks stemming from particular hazards. Depending on the context, more narrowly focused tools might then be selected to assess risk associated with jobs or tasks identified as problematic. This approach ensures that biomechanical risk factors are considered within a broad context of organizational and psychosocial risk factors. This is consistent with current research evidence on work- related causes of MSDs.     

The Life Rope: a transactional approach to exploring worker and life role development

The Model of Human Occupation offers a framework for analyzing occupational roles including that of worker; however, it does not describe the dynamics of role change after a traumatic injury. This paper reports a qualitative study of sixteen individuals who experienced a traumatic spinal cord injury in the midst of their occupational career development. The study examined their role change processes involved in redeveloping the worker role. Data were collected across 24 months of the participant's lives and triangulated via participant observations, guided interviews, mapping, and archival document review. Results showed that individuals formed multiple strands within their role repertoires at any point in time. After a traumatic injury, the worker role became an optional, elective role strand, one that often unraveled first as they encountered breakdowns in more basic survival roles, such as home manager, assistive technology user and attendant care employer. The metaphor of a Life Rope emerged as a useful conceptual framework for explaining life role development, including that of worker.     

Risk evaluation and exposure control of mineral dust containing free crystalline silica: a study case at a quarry in the Recife Metropolitan Area

During the production of aggregates at quarry sites, elevated quantities of micro-particulate mineral dust are produced in all stages of the process. This dust contains appreciable amounts of free crystalline silica in a variety of forms which, if maintained suspended in the air in the work environment, expose the workers to the risk of developing occupational silicosis, which causes reduced ability to work and potential shortening of lifespan. This study was conducted to qualitatively and quantitatively evaluate workers' exposure to mineral dust containing free crystalline silica at a midsized quarry in the Recife metropolitan area, in the State of Pernambuco. It involved evaluation of the industrial process, collection and analysis of representative dust samples, and interviews with the management team of the company with the intent to assess the compliance of the company with Regulatory Standard (NR) 22--Occupational safety and health in mining. In order to assist the company in managing risks related to dust exposure, three protocols were developed, implemented and made available, the first based on NR 22, from which the company was also given an economic safety indicator, the second based on the recommendations and requirements of Fundacentro to implement a Respiratory Protection Program and, finally, an assessment protocol with respect to the guidelines of the International Labor Organization to implement a health and safety management system. This study also showed the inadequacy of the formula for calculating tolerance limits in Brazilian legislation when compared with the more strict internationally accepted control parameters. From the laboratory results, unhealthy conditions at the quarry site were confirmed and technical and administrative measures were suggested to reduce and control dust exposure at acceptable levels, such as the implementation of an occupational health and safety management system, integrated with other management systems. From these assessments it is hoped that the proposals can assist the company in developing mechanisms for management and control of dust exposure risks that may improve environmental quality and the well-being of workers.     

Extent and sources of occupational stress in university staff

Canadian higher education sector has undergone numerous changes during the past decades. Increased student enrolments, massive cuts in human resources and constant restructuring are changes likely to have had a considerable impact on all employees (e.g., administrative, trades, and faculty). While many studies conducted in different countries have shown that stress in universities is a problem of alarming proportions, to date, no study of the entire staff of a university has been carried out in Canada. This research uses an approach based on the prevention and management of the sources of occupational stress to study 1086 employees of a Quebec university. Data were collected by means of questionnaires and semi-structured interviews. It was found that the proportion of individuals who reported a high level of psychological distress was twice as high (40%) than that reported for a Quebec-wide sample (20%). Work overload, the relationship with one's superior and participation in decision making were systematically reported as high risks to employees' health. It was found that human resources management practices have not followed the rapid organizational changes which affected the university in the past years. The results are discussed in light of the risk management approach.     

‘You care for your work; I'll care for your family’: perceptions of paternalistic managerial actions and employee commitment in Mexico

This study focuses on paternalism as a managerial strategy to foster employee commitment. Using in-depth, qualitative interviews during extended fieldwork at a Mexican multinational company, I examine employee perceptions of managerial actions within the context of workplace transformation. Employees perceived management as caring toward them and their families and characterized the workplace as a considerate and respectful environment. Employees interpreted managerial actions positively because a company cooperative provided family-supportive policies and cultivated a family-supportive culture, even after workplace transformation. Rather than disrupt the paternalistic practices, management combined them with the new strategic management practices. In exchange, employees were committed to the organization as evidenced by expressions of loyalty, pride, and appreciation. With its focus on how a specific family-supportive setting matters in the global south, this study extends the research on managerial strategies to promote employee commitment.     

How can occupational health services in Sweden contribute to work ability?

Occupational health service in Sweden is often described as an important and strategic resource to reduce work-related diseases, improve work ability and successfully assess improvement of the workplace. However, not much research has been done on how OHS contribute to reduced absence due to work-related illness or improvement of the work ability of employees. In our study, the ambition has been to describe how OHS can contribute and give effects in client companies. Fifteen companies considered to be good examples were selected in cooperation with the social partners. Semi-structured interviews were carried out with representatives of the company and OHS. The results show that efficient collaboration depend strongly on the relationship between the OHS and the company, and were highly correlated with a continuously dialogue and contact. Good occupational safety and health management at company level was a key factor for effective use of OHS. The strategic collaborations also often led to that OHSs contribution was gradually shifted from a reactive or medical focus to a more proactive approach. Several of the interviewed OHSs also held this strategy to work more with prevention, and focusing on "treating the organization", not the individual, leaving the executive measures to the company.     

Potential for violence toward psychiatric nursing students: risk reduction techniques

1. Nursing students could be vulnerable targets of violence in their psychiatric nursing clinical rotations by virtue of their predominant gender, and meek, insecure attitudes. 2. Nurses are taught to put the patients' needs first and students may blame themselves or minimize situations where they have been threatened or assaulted by a patient. Priority consideration must also be given to our own safety and that of our students, given the risk for occupational injury in the nursing workplace. 3. Affiliating agencies may restrict disabled students from patient care areas. Allowing a disabled student to participate in a clinical rotation on a psychiatric unit could put staff at unnecessary risk of violence if called on to protect the vulnerable student.     

Caught in the Middle? Worker Identity Under New Participatory Roles

This paper assesses four theories of the determinants of work identities of workplace participants. Data come from a case study of the General Motors team concept assembly plant in Shreveport, Louisiana. The findings indicate that Marxist theories of workplace control overestimate the extent to which management influences the identity of workplace participants. Some support was found for the Weberian perspective that work identity is determined by patterns of occupational mobility, yet strongest support was found for the Durkheimian focus on workplace norms. Implications are drawn regarding the meaning of employment in late modernity.     

Role of workplace safety: a revisit of the relationship between job satisfaction and employment status

This study evaluated the relationship between employment status (i.e., part- and full-time) and job satisfaction, with the focus on the moderating roles of perceived injury risk and injury incidence. The results found that the level of job satisfaction for full-time workers was about the same regardless of the level of injury risk they perceived. In contrast, job satisfaction of part-time workers was significantly higher when they perceived low injury risk rather than high injury risk. The findings also supported the potential adverse impact of injury incidence and injury risk on job satisfaction for both part- and full-time workers. This study highlighted the importance of understanding both workplace safety and job satisfaction when attempting to understand the differences between part-time and full-time workers.     

Strengthening Support to Families: Basing a Family Support Worker at a Primary School in Melbourne,Australia

This mixed methods study examines the benefits of basing a family support worker (FSW) at a primary school in Melbourne, Australia. The school has a number of high needs families requiring extensive support from school staff. Pre and post intervention data was collected on the time spent on social problems in the school community. These included managing students with behavioural and emotional issues, providing support and practical assistance to parents with problems and liaising with agencies to access support for students and families. Pre and post intervention Strengths and Difficulties Questionnaires were completed by teachers whose students and families were clients of the FSW (n = 8) and compared with non clients (n = 10). Semi-structured interviews were held with FSW clients (n = 6), class teachers (n = 3) the assistant principal, principal and the FSW. Employing a FSW showed a reduction in the amount of time spent on welfare cases for teachers, and therefore a monetary saving for the school. Qualitative data collected from school staff and FSW clients was overwhelmingly positive. Having a FSW based at a primary school provides savings in teacher time, and expenses to the school. Teachers are freed to concentrate on education and the parents valued the relationship provided by the FSW.     

A survey of occupational therapy in Australian work practice

While the prevention and management of work-related injuries are major areas of practice for Australian occupational therapists, there has been little research on occupational therapy's contribution in these areas. This study examined the characteristics of current Australian occupational therapy practice in the work arena. A postal questionnaire was sent to 355 occupational therapists employed in work practice from six of the eight state or territory Occupational Therapy Associations. The questionnaire enquired about demographic details, service provision in the prevention, assessment and rehabilitation areas and further education needs in these areas. The responses of 125 (35%) therapists were analysed and show the services commonly offered in prevention, assessment and rehabilitation. The most commonly offered services included job analyses, workplace assessment and suitable duties programs. The results also indicate high levels of service provision in the workplace. In presenting the findings of the survey, current trends in international and Australian occupational therapy work practice are discussed along with suggestions for directions in future education, practice and research.     

Individual and environmental factors related to job satisfaction in people with severe mental illness employed in social enterprises

Objective: The purpose of this study was to enhance understanding of the impact of individual and environmental variables on job satisfaction among people with severe mental illness employed in social enterprises.Participants: A total of 248 individuals with severe mental illness employed by social enterprises agreed to take part in the study. Methods: We used logistic regression to analyse job satisfaction. A model with job satisfaction as the dependent variable, and both individual (occupational self-efficacy and severity of symptoms perceived) and environmental (workplace) factors (provision of workplace accommodations, social support from co-workers, organizational constraints) as well as external factors (family support) as predictors, was tested on the entire sample. Results: All findings across the study suggest a significant positive impact of both individual and environmental factors on job satisfaction. People with higher occupational self-efficacy who were provided with workplace accommodations and received greater social support were more likely to experience greater job satisfaction.Conclusions: These results suggest that certain features of social enterprises, such as workplace accommodations, are important in promoting job satisfaction in people with severe mental illness. Further studies are warranted to expand knowledge of the workplace features that support employees with severe mental illness in their work integration process.     

Hot times,hot places. Youths’ risk perceptions and risk management in Chicago and Rotterdam

Many young people in low-income neighbourhoods are considered to be at risk of poor social outcomes and of becoming victims of violence and crime. This exploratory study focuses on how young people perceive risk and navigate their environment in two low-income, multi-ethnic neighbourhoods, one in Rotterdam and one in Chicago. We conducted in-depth interviews and mental mapping exercises with young people aged 14–19 in both sites. We found that neighbourhoods matter because they expose young people to certain kinds of risks, but also that their responses were shaped by their perceptions and interpretations of these risks. Moreover, we illustrate the dynamic and interactive nature of these processes of risk perception and management by discussing the ways in which different groups occupy and use, or travel through, public space at different times of the day. We argue that risk in disadvantaged neighbourhoods is not a static dimension in young people’s lives but rather emerges from an ongoing and complex interaction between perception, interpretation and response that can be seen as a kind of boundary work.     

Divers' Accounts of Normal Risk

This research examines how deep sea divers learn to expand notions of risk to include practices that violate formal training and may increase vulnerability to injury. Cultural constructions of “normal” or acceptable risk are learned in interaction with experienced divers who define the rules of membership and provide accounts that excuse or justify participation in high risk activities. The research explores how novice divers learn to distinguish categories of formal, normal, and excessive risk as they expand their risk involvement and attempt to achieve membership in the deep diving subculture. The study concludes with a discussion of risk normalization in everyday life and other leisure and occupational subcultures.     

Paternal Work Characteristics and Father‐Infant Interactions in Low‐Income,Rural Families

To examine the implications of paternal occupational conditions for the quality of father‐infant interactions, home visits, including interviews and videotaped observations of father‐infant interactions, were conducted with 446 fathers living in six low‐income, nonmetropolitan counties in North Carolina and Pennsylvania. When a variety of individual and demographic characteristics were controlled for, a less supportive work environment was associated with lower levels of fathers’ engaged and sensitive parenting. Significant interactions pointed to the importance of understanding combinations of risk factors. Experiencing high levels of workplace stressors, including low levels of self‐direction and high levels of care work, in the presence of other individual or demographic risk factors was associated with lower levels of father parenting quality.