64. Astrom S, Karlsson S, Sandvide A, Bucht G, Eisemann M, Norberg A, et al. Staff's experience of and the management of violent incidents in elderly care. Scand J Caring Sci 2004;18(4):410-6.
mon in various health care settings. This study aimed to describe emotional reactions among staff being exposed to violence in residential community care for the elderly: to investigate consequences from vio- lent incidents and to describe the management of violent incidents. Data were collected by telephone in- terviews with nursing staff reporting incidents of violence. During the period of investigation, 97 of 848 staff (11.4%) reported that they had been exposed to violence. More than one-third of them reported sub- sequent wound and bruises from the incident and two of the exposed staff consulted a doctor because of the violent incident. The most frequently reported reactions among the staff were aggression, astonish- ment, and antipathy against the perpetrating care recipient, as well as insufficiency, powerlessness, insult and fear. A majority of the incidents were judged as intentionally perpetuating from the care recipient. Most of the violent incidents were managed by informal discussions in the working team. A low number of the reported incidents of violence involved formal discussions with nurse managers.
65. Dellve L, Karlberg C, Allebeck P, Herloff B, Hagberg M. Macro-organizational factors, the incidence of work disability, and work ability among the total workforce of home care workers in Sweden. Scand J Public Health 2006;34(1):17-25.
Abstract: Aims: To investigate the importance of macro-organizational factors, i.e. organizational socio-
demographic and socioeconomic preconditions, of the municipal incidence of long-term sick leave, dis- ability pension, and prevalence of workers with long-term work ability among home care workers. Meth- ods: In an ecological study design, data from national databases were combined by record linkage. De- scriptive and analytical statistics were used to estimate and interpret macro-organizational factors (eco- nomic resources, region, unemployment, employment, occupational rehabilitation, return to work, age structures of inhabitants and home care workers). Results: The incidence of long-term sick leave among female home care workers was twice as high as that of male home care workers, and incidence of disabil- ity pension was about four times as high for the women. A great variation in municipal incidence of long- term sick leave, disability pension, and long-term work ability (101-264, 0.6-19.6, and 913-1,279 per 1,000 full-time equivalent workers and year) was also found. The strongest single factor for long-term work abil- ity was a high proportion of part-time or hourly paid employees, which explained 35% of the municipal variation. Macro-organizational factors explained long-term work ability (47-62% explained variance) bet- ter than long-term sick leave (33% explained variance). There was a low rehabilitation activity; only 2% received occupational rehabilitation and 5% of those on sick leave longer than 2 weeks returned to work within 30 days. Conclusions: The differences in the municipal proportion of work ability incidence indicate a preventive potential, especially related to employment and return to work after sick leave.
66. Di Tommaso ML, Strom S, Saether EM. Nurses wanted. J Health Econ 2009;28(3):748-57.
Abstract: When entering the job market, nurses choose among different kind of jobs. Each of these jobs
is characterized by wage, sector (primary care or hospital) and shift (daytime work or shift). This paper es- timates a multi-sector-job-type random utility model of labor supply on data for Norwegian registered nurses (RNs) in 2000. The empirical model implies that labor supply is rather inelastic; 10% increase in the wage rates for all nurses is estimated to yield 3.3% increase in overall labor supply. This modest re- sponse shadows for much stronger inter-job-type responses. Our approach differs from previous studies in two ways: First, to our knowledge, it is the first time that a model of labor supply for nurses is estimated taking explicitly into account the choices that RN's have regarding work place and type of job. Second, it differs from previous studies with respect to the measurement of the compensations for different types of work. So far, it has been focused on wage differentials. But there are more attributes of a job than the wage. Based on the estimated random utility model we therefore calculate the expected value of com- pensation that makes a utility maximizing agent indifferent between types of jobs, here between shift work and daytime work. It turns out that Norwegian nurses working shifts may be willing to work shift relative to daytime work for a lower wage than the current one.
67. Elstad JI, Vabo M. Job stress, sickness absence and sickness presenteeism in Nordic elderly care. Scand J Public Health 2008;36(5):467-74.
Abstract: AIMS: Nordic elderly care has been restructured to obtain more efficiency. Among workers
caring for the elderly, levels of perceived job stress could vary, due to understaffing and resource scarcity. This study examines how sickness absence and sickness presenteeism are associated with perceived job stress. METHODS: Data were obtained by posting questionnaires to lower-level care staff in Sweden (n=483), Denmark (n=704), Finland (n=597), and Norway (n=663). Self-reports about job stress (four items), sickness absence and sickness presenteeism were analysed by cross-tabulations and logistic re- gression. RESULTS: Each item of job stress was associated with sickness absence and sickness presen- teeism in the samples from all four countries. With low levels of job stress, levels of reported sickness ab- sence and sickness presenteeism were relatively moderate. With increasing levels of job stress, the level of sickness presenteeism rose more sharply than that of sickness absence. CONCLUSIONS: The results can be interpreted in the light of features inherent in care work. Owing to professional norms and moral obligations, care workers could lower their thresholds for taking sick leave when care organizations are understaffed, because absences will be particularly critical for care recipients in such circumstances. Thus, while increasing job stress tends to be accompanied both by more sickness absence and by more sickness presenteeism, sickness presenteeism rises particularly in cases of high levels of job stress. Ow- ing to cross-sectional data and self-reported information, conclusions are tentative
68. Flackman B, Sorlie V, Kihlgren M. Unmet expectations: Why nursing home staff leave care work. Interna- tional Journal of Older People Nursing 2008;3(1):55-62.
Abstract: Background: The shortages of healthcare professionals have been a common topic in care of
older people. Aim and objectives. The aim of the present study was to illuminate what caused the nursing home caregivers to decide to leave their employment. Design: A two-year intervention study was per- formed in three nursing homes in Sweden. Method: This qualitative interview study was conducted with 18 caregivers who decided to leave their employment during the first year. Content analysis was the method used to analyse the interviews. Result. The caregivers' decisions to leave their work in care of older people could be encompassed in one main category: `Unmet Expectations'. Their experiences were
lack of encouragement and trust and professional development. Feelings of insecurity, different opinions on the care delivered, being disregarded and betrayed followed as did thoughts of leaving work and purs- ing other opportunities. Conclusion: The main findings indicated that organizational work pressure with in- formation about pending financial cutbacks caused the caregivers to leave the nursing homes. Relevance to clinical practice: The study's results show the value of meeting the needs of caregivers, as caregivers consider that they meet the needs of the older people. Optimal use of caregivers' skills, experiences, competence and respect for their aspirations is also likely to result in cost-efficient care.
69. Forssen ASK, Carlstedt G, Mortberg CM. Compulsive Sensitivity--A Consequence of Caring: A Qualitative Investigation Into Women Carer's Difficulties in Limiting Their Labours. Health Care Women Int
2005;26(8):652-71.
Abstract: Women are expected to care, both in public and private life, for the sick as well as the healthy.
Some women have difficulties in limiting their caring, despite being deeply careworn. In this life-course study, based on in-depth interviews with elderly women in Sweden, the concept "compulsive sensitivity" presents a way toward understanding their difficulties. Compulsive sensitivity denotes the compulsion to see and respond to other people's needs, whatever one's own situation.
70. Isaksson U, Graneheim UH, Richter J, Eisemann M, Astrom S. Exposure to violence in relation to per- sonality traits, coping abilities, and burnout among caregivers in nursing homes: A case-control study. Scand J Caring Sci 2008;22(4):551-9.
Abstract: Background: Although violence toward caregivers occurs often and caregivers' ability to inter-
act and deal with difficult situations is relevant in preventing such violence, few studies have been con- ducted that focus on caregivers' characteristics. Aim: This study explores the relationship between per- ceived exposure to violence and demographical factors, parental rearing, personality traits including cop- ing abilities, defence styles, and burnout among caregivers working in nursing homes. Method: A total of 196 caregivers working in nursing homes were included. They were asked to complete questionnaires concerning demographical factors and exposure to violence. One group of female caregivers reporting no exposure to violence (n = 20) was matched with one group of exposed to violence (n = 20). Both groups were asked to complete questionnaires concerning parental rearing, personality traits, coping abilities, and burnout. Result: Around 68.4% of the caregivers had been exposed to violence during the previous year and 22.4% several times a week. Caregivers 50 years of age or younger and employed in geriatric care for more than 3 years were more frequently exposed to violence. Inter-group differences were found regarding 'maternal rejection' and 'burnout'. No statistical differences could be found concerning defence styles, coping ability, temperament, or character aspects. Conclusion: Violence toward caregivers occurs frequently and appears to be influenced by several factors. 'Maternal rejection' and 'burnout' among care- givers exposed to violence might influence the communication between caregivers and residents, render- ing more violence. However, personality traits among caregivers do not seem to be associated with expo- sure to violence.
71. Johannessen A. Rekruttering av sykepleiere til sykehjem - sykepleieres tanker og erfaringer. Vård i Nor- den 2004;24(4):45-7
72. Kloster T, Hoie M, Skar R. Nursing students' career preferences: a Norwegian study. J Advanced Nursing 2007;59:(2):155-62.
Abstract: Longitudinal research in Norway into the career preferences of student nurses at the start and
end of their preregistration programme. Students were asked to give reasons for their preferences and their specific reasons for decisions on whether or not to work in elderly care, mental health or home care nursing are discussed. 25 refs
73. Lewin S, Dick J, Pond P, Zwarenstein M, Aja GN, van Wyk BE, et al. Lay health workers in primary and community health care. Cochrane Database Syst Rev 2005;(1):CD004015.
Abstract: BACKGROUND: Lay health workers (LHWs) are widely used to provide care for a broad range
of health issues. However, little is known about the effectiveness of LHW interventions. OBJECTIVES: To assess the effects of LHW interventions in primary and community health care on health care behaviours, patients' health and wellbeing, and patients' satisfaction with care. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care and Consumers and Communication special- ised registers (to August 2001); the Cochrane Central Register of Controlled Trials (to August 2001); MEDLINE (1966- August 2001); EMBASE (1966-August 2001); Science Citations (to August 2001); CI- NAHL (1966-June 2001); Healthstar (1975-2000); AMED (1966-August 2001); the Leeds Health Educa- tion Effectiveness Database and the reference lists of articles. SELECTION CRITERIA: Randomised con- trolled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to promote health, manage illness or provide support to patients. A 'lay health worker' was defined as any health worker carrying out functions related to health care delivery; trained in some way in the context of the intervention; and having no formal professional or paraprofessional certificated or de- greed tertiary education. There were no restrictions on the types of consumers. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data onto a standard form and assessed study quality. Studies that compared broadly similar types of interventions were grouped together. Where feasi- ble, the results of included studies were combined and an estimate of effect obtained. MAIN RESULTS: Forty three studies met the inclusion criteria, involving more than 210,110 consumers. These showed considerable diversity in the targeted health issue and the aims, content and outcomes of interventions. Most were conducted in high income countries (n=35), but nearly half of these focused on low income and minority populations (n=15). Study diversity limited meta-analysis to outcomes for five subgroups (n=15 studies) (LHW interventions to promote the uptake of breast cancer screening, immunisation and breast- feeding promotion [before two weeks and between two weeks and six months post partum] and to im- prove diagnosis and treatment for selected infectious diseases). Promising benefits in comparison with usual care were shown for LHW interventions to promote immunisation uptake in children and adults (RR=1.30 [95% CI 1.14, 1.48] p=0.0001) and LHW interventions to improve outcomes for selected infec-
tious diseases (RR=0.74 [95% CI 0.58, 0.93) p=0.01). LHWs also appear promising for breastfeeding promotion. They appear to have a small effect in promoting breast cancer screening uptake when com- pared with usual care. For the remaining subgroups (n=29 studies), the outcomes were too diverse to al- low statistical pooling. We can therefore draw no general conclusions on the effectiveness of these sub- groups of interventions. AUTHORS' CONCLUSIONS: LHWs show promising benefits in promoting immu- nisation uptake and improving outcomes for acute respiratory infections and malaria, when compared to usual care. For other health issues, evidence is insufficient to justify recommendations for policy and practice. There is also insufficient evidence to assess which LHW training or intervention strategies are likely to be most effective. Further research is needed in these areas. LAY HEALTH WORKERS IN PRI- MARY AND COMMUNITY HEALTH CARE: Consumers, who are not certified health care professionals, may be trained to promote health and provide health care services. To determine whether these 'lay health worker' programmes are effective, 43 studies were found and analysed. The studies took place mostly in USA, Canada and the UK. Overall, lay health worker programmes appear to be effective for some kinds of healthcare, but there is not yet enough evidence to say that this is true for all or most kinds of healthcare. Compared to usual care,lay health worker programmes to increase immunization (vaccina- tion) in children and adults and programmes to improve health in people with lung infections and malaria may be effective. These programmes may also be effective in increasing breastfeeding, and in decreas- ing death in the elderly through providing home aide services. They may also have a small effect in in- creasing the uptake of breast cancer screening. There is not enough evidence to show whether lay health worker programmes are effective for other health care problems (for example, for managing high blood pressure or supporting alcoholics or mothers of sick children). It is also not known how best lay health workers should provide services and how much training they need to be effective
74. Lundstrom M, Graneheim UH, Eisemann M, Richter J, Astrom S. Personality Impact on Experiences of Strain Among Staff Exposed to Violence in Care of People With Intellectual Disabilities. Journal of Policy and Practice in Intellectual Disabilities 2007;4(1):30-9.
Abstract: Explored are the relationships among personality and emotional reactions, work-related strain,
and experiences of burnout among staff exposed vs. not exposed to violence when caring for people with intellectual disabilities (ID). Questionnaires measuring personality, emotional reactions, strain and burn- out, and exposure to violence were distributed to staff (n = 112) working in 22 group homes for people with ID aged 18 years and older in a community in northern Sweden. The results did not show evidence of a direct influence of personality variables on exposure to violence when working with people with ID and no direct relationships were found between exposure to violence and the staff members' personality traits as measured with the Temperament and Character Inventory and Rosenberg's Self-Esteem Scale. Although the influence of personality traits on how the staff members experienced violence could not be clearly determined, the authors found an association between personality and strain and the risk of burn- out in that certain staff exposed to violence felt more emotionally exhausted than did staff who were not exposed. The knowledge of the relationships among violence, personality, and risk of burnout may be im- portant for the understanding which staff need special supports when working with people with ID.
75. Magnusson A, Hogberg T, Lutzen K, Severinsson E. Swedish mental health nurses' responsibility in su- pervised community care of persons with long-term mental illness. Nurs Health Sci 2004;6(1):19-27.
Abstract: The aim of the present study was to describe psychiatric nurses' experience of how the chang-
ing focus of mental health care in Sweden, from in-patient treatment to community-based care, has influ- enced their professional autonomy. Eleven psychiatric nurses were interviewed and a qualitative content analysis was used to identify major themes in the data. Three main themes were found: pattern of re- sponsibility, pattern of clinical judgement, and pattern of control through support and supervision. All themes were related to the nurse's identity, moral responsibility and the feelings of loneliness and inde- pendence in his/her daily work. Together, the three themes were found to constitute a process. This study shows the complexity involved in nursing care provided in the patient's home. Achieving control over the patient's everyday life through support and supervision does not imply taking over the patient's autonomy, but rather reducing the stigma attached to mental illness and facilitating the process of rehabilitation
76. Nordam A, Torjuul K, Sorlie V. Ethical challenges in the care of older people and risk of being burned out among male nurses. J Clinical Nursing 2005;14:(10):1248-56.
Abstract: Qualitative research in Norway investigating male nurses' experiences of being in ethically dif-
ficult situations while caring for older people which may lead to burnout. A phenomenological hermeneutic method was used to analyse the narratives of 5 nurses, interpreting their views on caring and barriers to it, and emotional strain.
77. Romören TI. Jakten på de mange hendene. Rekruttering av personale til kommunale omsorgstjenester. Aldring og Livslöp 2008;25(3):2-10
78. Romören TI. Leder i pleie- og omsorgstjenesten: kompetanse, yrkeskarrierer og lokal tilhörighet. Aldring og Livslöp 2006;23(2):8-15
79. Saether EM. Nurses' labour supply with an endogenous choice of care level and shift type: A nested dis- crete choice model with nonlinear income. Applied Health Economics and Health Policy 2004;3(4):273- 80.
Abstract: It is argued that increasing wages will not only attract more nurses to the health sector, but
also increase the number of hours worked for those already there. This article focuses on the response of registered nurses employed in the public sector when they are allowed to endogenously choose between