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How do professional caregivers perceive their health and well-being?
Abstract
Purpose
The global ageing population places increased demands on the professional caregiver workforce. Literature reveals that although many in this workforce experience stress and fatigue, they also experience high levels of work satisfaction. These findings seem contradictory and therefore warrant further qualitative exploration. The purpose of this study was to explore how professional caregivers describe their health and well-being and to understand the interplay of work and life on health and well-being.
Design/methodology/approach
Data was collected via semi-structured individual or group interviews with 31 professional caregivers from in-home or residential care situations in three geographic locations across NZ and analysed for themes. The General Inductive Approach was used for data analysis.
Findings
We present two themes: ‘A holistic interpretation of health’, discusses caregivers’ perceptions of the meaning of health and well-being. Three interrelated sub-themes (‘Fulfilment of an inherent nature’, ‘Obligation to look after oneself’, and ‘Risk management’) reflect the interplay of factors which influence health and well-being as a caregiver and make up the second theme of ‘Being in tune’. If balance was not achieved, caregivers recognised this as a risk to their health and well-being, especially to their psychological health, and considered leaving the profession.
Originality/value
We identified that caregivers considered health and well-being from a holistic perspective. They had insight into factors influencing their health. Despite high levels of stress, there was an overall positive perception of health and well-being that appears due in part to participating in a profession that fulfils an inherent nature. Collaborative problem-solving between management and workforce, alongside recognising and affirming the unique skills of this workforce may help to empower caregiver resilience.
... Studies have consistently found a positive association between mindfulness (nonjudgmental awareness of the present moment) and MWB (Grégoire et al., 2015;Lahtinen et al., 2016;Lonas et al., 2017;Sampath et al., 2019;Shawn & Englund-Helmeke, 2014;Soysa et al., 2020;Sugiura & Sugiura & Suguira, 2018;Suyi et al., 2017). Positive psychosocial correlates of caregivers' MWB include social support, use of stress management strategies, collaborative problem solving, sense of mastery of caregiving situation, seeing caregiving as a self-fulfilling profession, experiencing less demands of caregiving, experiencing less problem behaviours from psychiatric patients and caregiver's increased self-esteem (Perry et al., 2017;Sołtys & Tyburski, 2020). Among other professionals, job satisfaction has been linked to improved MWB (Picco et al., 2017). ...
Professional caregivers of psychiatric patients are often exposed to circumstances and environments that threaten their mental well-being in the course of carrying out their professional duties. In this study, we examined the mediating role of emotion regulation in the association between mindfulness and mental well-being among professional caregivers of psychiatric patients. Three hundred and seven professional caregivers of psychiatric patients whose ages ranged between 22 and 63 years (mean age = 39.21 years; SD = 10.09 years) participated in the study. They completed measures of mindfulness, emotion regulation and mental well-being in addition to supplying relevant demographic information. Results of mediation analysis showed that expressive suppression dimension of emotion regulation mediated the relationship between mindfulness and mental well-being. This indicates that mindfulness was associated with increased mental well-being via the pathway of reduced expressive suppression. These findings suggest that expressive suppression may represent an effective way to strengthen the link between mindfulness and mental well-being among professional caregivers and ultimately provide a means to improve their well-being.
... Three participants responded expressing their enjoyment of being involved but no changes were made to the results following this process. Perry et al. [40] demonstrate the highly iterative and structured process of this type of analysis. ...
Urban parks are spaces that can enhance older adults’ physical, social and psychological wellbeing. As the prevalence of older adults with disability increases, it is important that urban parks are accessible to this population so that they too might gain health benefits. There is limited literature investigating the experiences of urban parks by older adults with disability. This qualitative study, set in a region of New Zealand, explored the experiences, including accessibility, of urban parks by 17 older adults (55 years and older) with self-reported disabilities. Three focus groups (n = 4, 5 and 4 people) and four individual interviews were undertaken. Data were analyzed using the General Inductive Approach. Two primary themes of “Enticing” and “Park use considerations” are presented. Urban parks and green spaces are perceived to provide an environment for older adults with a disability to improve their physical, psychosocial and spiritual health, and social connectedness. Parks that are not age, ability or culture diverse are uninviting and exclusive. Meaningful collaboration between park designers, city councils and people with disability is required to maximize the public health benefits of parks and make parks inviting and accessible for users of all ages, cultures and abilities. Park co-design with people with disability may provide one means of improving accessibility and park usability and thus park participation by older adults with disability.
... An unfavourable work environment is viewed as a main contributing factor in attrition, related to heavy workload, psychological and emotional stress, unrealistic time to complete care activities, working in isolation, poor organizational support and lack of education and training (Costello et al. 2019;Hodgkin et al. 2017). Care workers in this environment show poor health and well-being, perceived burnout and low level of job satisfaction (Costello et al. 2019;Perry et al. 2017). ...
Aims
To identify the reasons why workers decide to enter, stay or leave the aged care workforce; and the factors influencing them to transition between community and residential sectors in Australia.
Background
Factors affecting the recruitment and retention of suitable care workers in aged care are complex and influenced by personal, institutional and societal factors.
Methods
A qualitative description study design.
Results
In total, 32 staff participated in the study. Five main themes were identified: entering aged care with a passion for the job; entering aged care as it is the only employment option; factors attracting care workers to stay in aged care; factors influencing care workers to leave the job; and preferring to work in residential aged care rather than community aged care.
Conclusion
Issues relating to the attraction and retention of aged care workers are influenced by personal, institutional and societal factors. Critical shortages in the aged care workforce make the industry more susceptible to crises such as COVID‐19 outbreaks.
Implication for nursing practice
Aged care organizations need to create a positive psychosocial work environment for staff to improve the attraction and retention of skilled care workers. They also need to develop staff recruitment guidelines to ensure care workers with the appropriate skills and training and a passion for working with older adults are selected. Staff development programmes need to focus on learning activities that enable staff to build peers support in the work environment.
Implications for health policy
There is a need to mandate curriculum to enable nursing students to receive more gerontological education and exposure to aged care throughout their education. Aged care quality standards need to mandate transition support for new graduate nurses.
The present research aims to investigate the relationship between the caregiving burden and its impact on the mental health of caregivers of chronically sick patients. It was hypothesized that the caregiving burden would be positively associated with higher levels of depression, anxiety, and stress among caregivers of chronically sick patients; and caregiving burden would significantly predict the psychological distress (depression, anxiety, stress) in caregivers of chronically sick patients. A sample of 220 caregivers (n=220) was selected conveniently which comprised of 102 males and 118 females selected from the different hospitals. The study employed a correlational research design to collect data, using two standardized scales, the Depression, Anxiety, and Stress Scale-21 (DASS-21) and Zarit Burden Interview. The data were analyzed by using SPSS to investigate the relationship between the caregiving burden and the caregivers' mental health. The findings showed a significant relationship between caregiving burden and increased psychological distress. This implies that higher caregiving burden leads to higher psychological distress. The findings emphasize the importance of proper interventions and support facilities for caregivers. The study adds to the existing knowledge by addressing the impact of the caregiving burden. Additional research is needed to investigate the potential mediator or moderators of the association between the burden and the mental health outcomes, thereby improving our understanding of the intricacies of caregiving experiences.
Background
Support workers are central to the delivery of residential aged care, but the workforce is facing increasing work demands and widespread shortages. This contributes to high rates of burnout, decreased job satisfaction and high staff turnover. Peer-led interventions are reported to be effective but it is necessary to use evidence-based interventions to support this key workforce group.
Objective
This study aimed to evaluate the scientific evidence on effectiveness of strategies improving psychosocial and turnover-related outcomes for support workers in aged care that could be incorporated into a peer-led intervention.
Design
Systematic review and meta-analyses of experimental and quasi-experimental studies.
Setting
Residential aged care.
Methods
A systematic literature review was conducted using MEDLINE (via PubMed), EMBASE (via Scopus), and CINAHL (via EBSCO). We included studies examining the effectiveness of workplace interventions aiming to reduce aged care support workers' turnover rates and/or improve their work-related psychosocial outcomes (such as work stress, job satisfaction, self-esteem, and other). A number of meta-analyses using a mixed-effects model were performed to calculate standardized mean differences and odds ratios.
Results
Fifty-one studies were included: 15 randomised controlled trials (RCTs), 19 non-RCTs and 17 Pre-Post studies. Most of the studies were rated as having ‘high’ or ‘very high risk of bias’. The studies were clustered by intervention type: 1) knowledge-based, 2) interpersonal skills-based, 3) team-building, and 4) self-care. Knowledge-based interventions were the most used approach, with 26 studies in this category, and frequently reported improvements in stress- and satisfaction-related outcomes. There were twelve interpersonal skills-based and nine team-building interventions, which often reported decreased work stress, staff turnover, and intention to quit. There were four self-care interventions of which only one reported improvements in stress-related outcomes. Meta-analyses showed that only knowledge-based interventions resulted in statistically significant improvements: lower staff turnover rates (OR 0.47, 95 %CI: 0.37, 060), and higher scores for job/life satisfaction (SMD 0.26, 95 % CI: 0.05, 0.46) and staff attitude (SMD 0.23, 95 % CI: 0.05, 0.45).
Conclusion
This review found numerous strategies that have been trialled to improve support workers’ psychosocial- and turnover-related outcomes. Most studies reported improvements in outcomes. However, our meta-analyses suggest that the effect sizes were small and mostly non-significant, with the evidence being of low certainty. The evidence for effectiveness of knowledge-based interventions appears the most convincing, with statistically significant improvements reported for turnover rates, job/life satisfaction and staff attitude. More high-quality studies are needed to consolidate the existing evidence.
PROSPERO registration number
CRD42017059007; 02 June 2017.
Tweetable abstract: Knowledge-based interventions most promising in improving support workers’ outcomes in aged care. #agedcare #staffturnover
Purpose
Employees eat at least one meal per day in the workplace on a regular basis, carrying implications for their physical and emotional well-being. For migrants, this can be challenging, owing to food culture differences. This study explores migrant workers’ perceptions of the food eaten in the hospitality workplace.
Design/methodology/approach
Eleven in-depth, face-to-face, semi-structured interviews were carried out with migrant workers in three- and four-star hotels in the southwest of England.
Findings
The findings show that the food eaten in the workplace is perceived as unhealthy and fattening and therefore unappealing. This partly informs a decision to eat home country food away from work.
Research limitations/implications
Further research is needed across many more organisations to investigate whether this would actually have the positive impact on employee well-being (migrant or home national) and employer reputation.
Practical implications
Providing additional “off-menu” meals for migrant employees is recognised. However, staff turnover within the hotel environment may mean that dishes acceptable to one nationality may not be acceptable to another. Alternatively, it may be that attention to such details and the provision of a food offering that is seen as fit for purpose by staff may reduce turnover and demonstrate “care” on the part of the employer. An annual staff survey could be conducted to gauge employee opinion.
Social implications
This study helps to show the significance of food for migrant well-being. It highlights that in increasingly globalised workplaces, food provision is important for both emotional and physical health. The study's findings have relevance to other multicultural workplaces where the food provided to staff may have consequences for employee well-being.
Originality/value
Little research has focused on the link between the food consumed in the hospitality workplace and migrant worker well-being. This study therefore makes an important contribution to knowledge by exploring feelings about the food eaten at work from the perspective of migrant workers themselves.
Background
Unregulated health care aides provide the majority of direct health care to residents in long term care homes. Lower job satisfaction as reported by care aides is associated with increased turnover of staff. Turnover leads to inferior job performance and negatively impacts quality of care for residents. This study aimed to determine the individual and organizational variables associated with job satisfaction in care aides. Methods
We surveyed a sample of 1224 care aides from 30 long term care homes in three Western Canadian provinces. The care aides reported their job satisfaction and their perception of the work environment. We used a hierarchical, mixed-effects ordered logistic regression to model the relative odds of care aide job satisfaction for individual, care unit, and facility factors. ResultsCare aide exhaustion, professional efficacy, and cynicism were associated with job satisfaction. Factors in the organizational context that are associated with increased care aide job satisfaction include: leadership, culture, social capital, organizational slack—staff, organizational slack—space, and organizational slack—time. Conclusions
Our findings suggest that organizational factors account for a greater increase in care aide job satisfaction than do individual factors. These features of the work environment are modifiable and predict care aide job satisfaction. Efforts to improve care aide work environment and quality of care should focus on organizational context.
Purpose:
To identify agency policies and workplace characteristics that are associated with intent to leave the job among home health workers employed by certified agencies.
Design and methods:
Data are from the 2007 National Home and Hospice Care Survey/National Home Health Aide Survey, a nationally representative, linked data set of home health and hospice agencies and their workers. Logistic regression with survey weights was conducted to identify agency and workplace factors associated with intent to leave the job, controlling for worker, agency, and labor market characteristics.
Results:
Job satisfaction, consistent patient assignment, and provision of health insurance were associated with lower intent to leave the job. By contrast, being assigned insufficient work hours and on-the-job injuries were associated with greater intent to leave the job after controlling for fixed worker, agency, and labor market characteristics. African American workers and workers with a higher household income also expressed greater intent to leave the job.
Implications:
This is the first analysis to use a weighted, nationally representative sample of home health workers linked with agency-level data. The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them.
Based on the Job Demands-Resources (JD-R) model, this study explored the role of physical injury and organizational support in predicting home health workers’ turnover intention. In a sample of home health workers in Central Texas (n = 150), about 37% reported turnover intention. Logistic regression model showed that turnover intention was 3.23 times more likely among those who had experienced work-related injury. On the other hand, organizational support was found to reduce the likelihood of turnover intention. Findings suggest that injury and organizational support should be prioritized in prevention and intervention efforts to promote home health workers’ safety and retention.
Health and well-being in the workplace have become common topics in the mainstream media, in practitioner-oriented magazines and journals and, increasingly, in scholarly research journals. In this article, we first review the literature that serves to define health and well-being. We then discuss the primary factors associated with health and well-being, the consequences of low levels of health and well-being, and common methods for improving health and well-being in the workplace. Finally, we highlight important future directions for future theory, research, and practice regarding health and well-being from an organizational perspective.
Purpose
This paper aims to provide an overview of the inequalities between three countries – England, The Netherlands and Taiwan – in relation to the welfare and long‐term care of older people. It compares the positive and negative distinctions between the respective countries and their systems.
Design/methodology/approach
This paper discusses and analyses data from public sources and literature and measures the similarities and differences between demographic and social issues, the cultural and political differences shaping policy objectives, economic constraints and long‐term care services.
Findings
All three countries face similar pressure in long‐term care provision of ageing populations, funding limitations and shrinking numbers of carers. None of the countries studied completely conforms to Esping‐Andersen's ideal types; instead they seem to constitute hybrids. The care system in the Dutch social democratic‐conservative welfare regime seems to provide wider support for older people who need care, the English liberal‐social democratic welfare regime comes second and Taiwanese conservative‐liberal welfare regime comes third. Overall, some converse trends of the long‐term care systems indicate a narrowing of the gap in responsibility between state, family and individuals in the East and the West.
Practical implications
The paper contributes suggestions to further research in the area of elements and structures of care systems support and the failure to provide ongoing quality of long‐term care and reflects on the implications for the global market of care‐workers and the extensive use of migrant workers in the field.
Originality/value
The paper provides a detailed consideration of the wide‐ranging issues that impact on older people's care provision in England, The Netherlands and Taiwan.
Background
The salutogenic model states that coping resources are defined within sociocultural and historical contexts and that various social and historical factors influence the availability of such resources. Though previous studies have suggested the need for an interregional comparison of psychological and social resources, few studies have undertaken such an investigation. The aim of this study is to investigate the associations among coping resources, sense of coherence (SOC), and health status in a comparison of urban and rural residents.
Methods
General residents (aged 30–69 years) in two areas were targeted for the current study. Through a random sampling selection, 1,000 residents from each area were picked, and an anonymous questionnaire was mailed to each resident. Ultimately, 269 and 363 valid responses from the urban and rural areas, respectively, were analyzed. SOC, both social and psychological resources, and mental health were assessed. To examine relationships between SOC and resources associated with mental health, mental health was defined as a dependent variable. Hierarchical multiple regression was conducted with variables entered from sociodemographic characteristics, social and psychological resources, and SOC.
Results
Regarding regional characteristics, social capital and participation in community activities were significantly greater in the rural area than in the urban area. Urban residents reported significantly higher self-esteem and optimism than rural residents. SOC showed the most significant association with mental health in both areas. Mental health was significantly associated with physical activity limitations and life stressors in both areas. However, the associations were weakened when social and psychological resources and SOC were added, which demonstrated their buffering effect on the negative influence of life stressors on health. When SOC was added, the association of self-esteem with mental health disappeared in both areas, but optimism in the urban area and humor in the rural area were directly and independently associated with mental health.
Conclusions
Our findings indicate that resources available to urban and rural residents are characteristic of the area where they live, and that social and psychological resources as well as SOC are associated with better mental health. Possible directions for health support strategies, reflecting regional characteristics, are suggested.
New Zealand's population is ageing due to a decline in the fertility rate and increases in life expectancy. The incidence of disability increases with age. This is a crucial factor in the future need for care. Department of Labour estimates suggest that the number of paid caregivers needs to almost treble in order to meet the needs of the projected number of disabled older people requiring a high level of care and support. The purpose of this paper is to examine the current supply of paid caregivers for the elderly in New Zealand by developing a demographic profile of the caregiver workforce in New Zealand, and to project the future demand for paid caregivers.
Studies of childhood abuse and neglect haveimportant lessons for considerations of natureand nurture. While each child has uniquegenetic potentials, both human and animalstudies point to important needs that everychild has, and severe long-term consequencesfor brain function if those needs are not met. The effects of the childhood environment,favorable or unfavorable, interact with all theprocesses of neurodevelopment (neurogenesis,migration, differentiation, apoptosis,arborization, synaptogenesis, synapticsculpting, and myelination). The time coursesof all these neural processes are reviewed herealong with statements of core principles forboth genetic and environmental influences onall of these processes. Evidence is presentedthat development of synaptic pathways tends tobe a ``use it or lose it'' proposition.Abuse studies from the author's laboratory,studies of children in orphanages who lackedemotional contact, and a large number of animaldeprivation and enrichment studies point to theneed for children and young nonhuman mammals tohave both stable emotional attachments with andtouch from primary adult caregivers, andspontaneous interactions with peers. If theseconnections are lacking, brain development bothof caring behavior and cognitive capacities isdamaged in a lasting fashion.These effects of experience on the brainimply that effects of modern technology can bepositive but need to be monitored. Whiletechnology has raised opportunities forchildren to become economically secure andliterate, more recent inadvertent impacts oftechnology have spawned declines in extendedfamilies, family meals, and spontaneous peerinteractions. The latter changes have deprivedmany children of experiences that promotepositive growth of the cognitive and caringpotentials of their developing brains.
With the growth of the older adult population increasing at an exponential rate, caring for this population has become increasingly difficult. As many choose to age in place (i.e., in the home environment), both the public and private sectors are being forced to respond. The emergence of home health care and the employment of home care aides is one of the ways that the industry has evolved to meet this crisis. However, retention of home care aides has proven problematic. This study explores factors affecting home care aide retention in agencies that employ home care aides. A sample of 116 home care aides employed by three agencies was surveyed to identify retention issues relative to the home care aide. A hypothetical model of home care aid job retention was tested with a hierarchical regression analysis, where 11 variables were entered in five steps, using a time-sequenced order. The results indicated that the hypothetical model was able to explain 41% of the variance in months employed as home care aides, with age, education, wages earned, and intrinsic satisfaction as the most significant contributors to the model. Being able to predict retention of home care aides allows employing agencies to realign themselves to retain workers and improve quality of care. However, it is important to realize that the same traits that predict retention among home care aides may also leave these workers vulnerable to exploitation.
A general inductive approach for analysis of qualitative evaluation data is described. The purposes for using an inductive approach are to (a) condense raw textual data into a brief, summary format; (b) establish clear links between the evaluation or research objectives and the summary findings derived from the raw data; and (c) develop a framework of the underlying structure of experiences or processes that are evident in the raw data. The general inductive approach provides an easily used and systematic set of procedures for analyzing qualitative data that can produce reliable and valid findings. Although the general inductive approach is not as strong as some other analytic strategies for theory or model development, it does provide a simple, straightforward approach for deriving findings in the context of focused evaluation questions. Many evaluators are likely to find using a general inductive approach less complicated than using other approaches to qualitative data analysis.
This article describes the theoretical foundation and methodology used in a study intended to increase knowledge concerning informal caregivers' resources to health (in salutogenesis; General Resistance Resources, GRRs). A detailed description of how the approach derived from salutogenic theory was used and how it permeated the entire study, from design to findings, is provided. How participation in the study was experienced is discussed and methodological improvements and implications suggested.
Using an explorative, mixed method design, data was collected through salutogenically guided interviews with 32 Swedish caregivers to older adults. A constant comparative method of analysis was used to identify caregiver-GRRs, content analysis was further used to describe how participation was experienced.
The methodology unraveled GRRs caregivers used to obtain positive experiences of caregiving, but also hindrances for such usage contributing to negative experiences. Mixed data made it possible to venture beyond actual findings to derive a synthesis describing the experienced, communal context of the population reliant on these GRRs; Caregivinghood. Participating in the salutogenic data-collection was found to be a reflective, mainly positive, empowering and enlightening experience.
The methodology was advantageous, even if time-consuming, as it in one study unravelled caregiver-GRRs and hindrances for their usage on individual, communal and contextual levels. It is suggested that the ability to describe Caregivinghood may be essential when developing health-promoting strategies for caregivers at individual, municipal and national levels. The methodology makes such a description possible and suggested methodological improvements may enhance its usability and adaptability to other populations.
Dementia increasingly impacts every health and social care system in the world. Preparing the dementia care workforce is therefore paramount, particularly in light of existing problems of staff retention and turnover. Training interventions will need to increase worker and organizational capacity to deliver effective patient care. It is not clear which training interventions best enhance workers' capacity. A review of the evidence for dementia care training interventions to enhance worker capacity and facilitate organizational change is presented.
A systematic literature review was conducted. All selected randomized intervention studies aimed to enhance some aspect of dementia care worker or workforce capacity such as knowledge of dementia, psychological well-being, work performance, and organizational factors such as retention or service delivery in dementia care.
Seventy-four relevant studies were identified, but only six met inclusion criteria for the review. The six studies selected focused on worker and organizational outcomes in dementia care. All interventions were multi-component with dementia education or instructional training most commonly adopted. No interventions were found for the community setting. Variable effects were found for intervention outcomes and methodological concerns are raised.
The rigor of scientific research in training interventions that aim to build capacity of dementia care workers is poor and a strong need exists for evaluation and delivery of such interventions in the community sphere. Wider domains of interest such as worker psychological health and well-being need to be examined further, to understand capacity-building in the dementia care workforce.
Huber and colleagues rightly challenge the validity, in the 21st century, of the World Health Organization’s definition of health.1
Adaptation and self management are important qualities, but a contemporary definition should include health being a human right protected by certain entitlements and a resource for life that is affected by social, political, economic, and environmental factors.2 …
The current WHO definition of health, formulated in 1948,
describes health as “a state of complete physical, mental and
social well-being and not merely the absence of disease or
infirmity.”1 At that time this formulation was groundbreaking
because of its breadth and ambition. It overcame the negative
definition of health as absence of disease and included the
physical, mental, and social domains. Although the definition
has been criticised over the past 60 years, it has never been
adapted. Criticism is now intensifying,2-5 and as populations age
and the pattern of illnesses changes the definition may even be
counterproductive. The paper summarises the limitations of the
WHO definition and describes the proposals for making it more
useful that were developed at a conference of international health
experts held in the Netherlands.6
This research applies a stress and support conceptual model to investigate the effects of background characteristics, personal and job-related stressors, and workplace support on direct care workers' (DCW) job satisfaction.
Researchers collected survey data from 644 DCWs in 49 long-term care (LTC) organizations. The DCWs included nurse assistants in nursing homes, resident assistants in assisted living facilities, and home care aides in home health agencies. We examined the influence of components of the LTC stress and support model on DCW job satisfaction. Initially, we ran a multiple regression analysis by entering individual-level DCW predictors with job satisfaction as the outcome. Subsequently, we used hierarchical linear modeling to examine the influence of organizational factors on DCW job satisfaction after controlling for significant individual-level DCW variables.
Components of the model explained 51% of the variance in DCW job satisfaction. Background characteristics of DCWs were less important than personal stressors (e.g., depression), job-related stressors (e.g., continuing education), and social support (e.g., interactions with others) in predicting job satisfaction. Results from hierarchical linear modeling analysis showed that nursing homes compared to the two other types of LTC organizations had lower average DCW job satisfaction rates, as did organizations offering lower minimum hourly rates and those reporting turnover problems.
Study findings underscore the importance of targeting both DCW-level and organizational-level factors to increase DCW job satisfaction.
This study examined the association among caregivers' five-factor personality traits and subjective health with particular emphasis on the role of two theoretically implicated mediators: multi-domain self-efficacy and caregiver strain. The sample comprised 536 informal caregivers (mean age = 62.9 years, SD = 19.9, 72% female, 98% White) of community-dwelling older adults with multiple functional impairments. Both physical health and mental health were negatively associated with neuroticism and positively associated with extraversion and conscientiousness. Agreeableness and openness were associated with better subjective mental health and physical health, respectively. Multiple mediation analyses indicated that self-efficacy mediated all observed associations between personality and subjective health, whereas caregiver strain selectively mediated the associations of neuroticism and agreeableness with mental health.
The goal of this article is to explore physicians' perceptions of their colleagues' awareness of the link between physician wellness and the quality of care they provide to their patients. In addition, we also examine potential factors that may be related to physicians' recognition or lack of recognition of this link. We rely on qualitative interview data from a sample of 42 physicians representing the spectrum of different medical specialties and work settings in a single health region in Western Canada. Our findings suggest that many physicians believe the link between physicians' well being and the quality of care they provide their patients is not necessarily at the forefront of most doctors' awareness as they practice medicine on a day-to-day basis. Our study participants identified a number of factors that may explain this finding and that reflect two broad themes: the culture of medicine and physicians' overwhelming workload. In regards to the culture of medicine, the physicians in our study reported how doctors view themselves as invincible caregivers first and foremost who must look after others before looking after themselves, who believe they do not need help from others and who are highly committed to their patients, careers and sense of professionalism. In regards to physicians' workloads, our study participants identified external pressures in the workplace in terms of how their busy schedules and the overwhelming nature of their work are significant deterrents that often prevent them from thinking about their own wellness. We discuss how the culture of medicine and physicians' workloads deter doctors from recognizing signs of unwellness and caring for themselves. We conclude that not only individual physicians, but also their peers, their patients, employing organizations and the health care system must appreciate and support physicians in their efforts to protect and maintain their personal well being.
The developed world's population is aging, due to trends of increased life expectancies and decreased fertility rates. These trends are predicted to increase demand on long-term care services. At the same time, the long-term care workforce is in shortage in most of the developed world. Moreover, such shortages are expected to increase due to parallel socio-demographic factors. The increase in demand for longterm care, coupled with shortage in supply of care workers, has promoted some attention from policymakers. The current paper provides an international review of institutional arrangements for long-term care in different developed countries and in particular explores different strategies used or proposed to resolve the shortage in the long-term care workforce.
The aim of this paper is to synthesise empirical findings on the salutogenic concept sense of coherence (SOC) and examine its capacity to explain health and its dimensions.
The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992-2003. The review includes 458 scientific publications and 13 doctoral theses.
Worldwide, based on postgraduate scientific publications in eight authorised databases, doctoral theses, and available books.
SOC is strongly related to perceived health, especially mental health. The stronger the SOC the better the perceived health in general, at least for those with an initial high SOC. This relation is manifested in study populations regardless of age, sex, ethnicity, nationality, and study design. SOC seems to have a main, moderating or mediating role in the explanation of health. Furthermore, the SOC seems to be able to predict health. SOC is an important contributor for the development and maintenance of people's health but does not alone explain the overall health.
SOC seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Salutogenesis is a valuable approach for health promotion and would be worth to implement in practice much more than to date.
This paper reports a study to investigate coping strategies and sense of coherence in relation to gender, the extent of care, caregiving activities and health-related quality of life in a population-based sample of caregivers aged 75 and over.
Caring for another person can be stressful both emotionally, and caregiver burden may affect quality of life in a negative way for the carer. Caregivers' experience of burden may depend on for example, the behaviour of the person cared for, their own health and their sense of coherence. Older people take a great part of caregiving responsibility and thus understanding of their strain and coping is required.
A postal survey was carried out in 2001 with 171 informal caregivers, aged 75 or older. The response rate was 47%. The questionnaire included the Short-Form 12, Carer's Assessment of Managing Index, and Sense of Coherence instrument.
Almost 70% of caregivers provided help every day. Higher health-related quality of life was predicted by using self-sustaining coping strategies and by high sense of coherence. Poor economic situation and demanding social and practical support predicted low scores.
These findings could help identify those at risk of low quality of life due to caregiving, dysfunctional coping or lack of information about care. Early intervention, including education about alternative coping strategies and practical information, might allow caregivers better possibilities to continue caring with less negative effects on their lives.
The home care workforce, already at 2.7 million caregivers, will become the nation’s fastest growing occupation by 2024 as the senior boom generation accelerates the demand for in home services to meet its long-term care needs. The physically challenging work of assisting clients with intimate, essential acts of daily living places home care workers (HCWs) at risk for musculoskeletal disorders (MSDs); yet, HCWs typically receive little formal job training and may lack appropriate assistive devices. In this qualitative pilot study, HCW focus groups described workplace MSD risk factors and identified problem-solving strategies to improve ergonomic conditions. The results revealed that HCWs rely on their behavioral insights, self-styled communications skills and caring demeanor to navigate MSD risks to themselves and increase clients’ physical independence of movement. We suggest changes in employer and government policies to acknowledge HCWs as valued team members in long-term care and to enhance their effectiveness as caregivers.
In Australia, workforce shortages in residential aged care present a significant challenge for the aged care industry. The growing demand for workers in aged care, combined with the shrinking supply of younger workers entering the field, highlights a future workforce crisis. The current shortfalls are set to worsen with the retirement of a generation of women who have provided the backbone of the workforce. Although targeted retention of this group may alleviate this issue, few studies have explored the retirement decisions of this cohort. This paper reports on a qualitative study of this cohort of Victorian public sector residential aged care staff. Although current government rhetoric promotes intrinsic rewards (altruism, moral fulfilment) over extrinsic rewards (excessive workload, pay and conditions), a combination of these factors was associated with job satisfaction. It would seem timely to revisit some of these concerns to ensure an adequate and sufficiently skilled workforce.
This study explored aged care support workers’ perceptions of how their health was influenced by their job, highlighting similarities and differences of those working in community-based and institution-based care. Support workers working in two institution-based and three community-based aged care organisations were invited to participate. Semi-structured interviews were undertaken with ten participants. Open-ended questions probed participants’ perceptions of their health as it related to their work. Data were analysed with the General Inductive Approach. Four central themes were identified, many of which related to mental, as opposed to physical health. ‘Love of the job’ described various sources of satisfaction for participants. These factors commonly overrode the negative aspects. ‘Stress’ encompassed the negative influences on all aspects of health. ‘Support’ described the positive influences on health, which supported participants in their job. ‘Physicality’ described the physical nature of the job and the positive and negative impact this had on participants’ health. Support workers perform numerous tasks, which often impact upon their health. Aspects of the job that may impact the health of the worker are improved communication and support from management, as well as recognition for support workers’ contribution to society. These could be targeted to enhance support worker health. Additional training and reduced time pressure may also represent aspects for improvement, to optimise support workers’ physical health.
Given the universal pressures within the health and elderly care sectors for cost reduction and the need for high-quality care, the effective management of the workforce in care organizations is of critical importance. In this article, we examine the changing landscape of the health care and aged care systems and identify key challenges for the human resource management (HRM) field. We assess existing research evidence on the role of HRM and high-performance work systems in the health care sector. We also outline a number of research areas as fruitful avenues for future studies, drawing particular attention to aged care as an underresearched subsector, and immigrants as an important group of research targets. The key message of our article is that future research on HRM in the care sector has much to gain by adopting an interdisciplinary, multilevel, and multistakeholder approach. More cross-sectoral and cross-country comparative studies of HRM in health care and other care work are also needed to shed light on how policy orientations, institutional arrangements, social norms, and cultural traditions influence care regimes across different societies, and to encourage the sharing of learning across societies. © 2015 Wiley Periodicals, Inc.
Background: With the proportion of the population aged over 65 expecting to rise from 15 to 26% within the next 50 years, the demand for formal support workers for older adults will rise substantially. It is essential that this workforce remain healthy; however, due to the nature of elder care, musculoskeletal complaints are commonplace in support workers.
Objectives: The aim of this systematic review was to determine the current work-related musculoskeletal disorders which are present in workers in the aged care sector.
Method: Five databases were searched: AMED, CINAHL, EMBASE, Medline, and Web of Science. Four main concepts: aged care, physical health, carer/support worker, and work, were included in the search. All study design types where participants were involved in the formal care of the older adults were included.
Results: The search yielded 17 articles after the implementation of strict inclusion and exclusion criteria. Common musculoskeletal complaints included neck, shoulder, and back pain with a prevalence ranging between 5 and 51%. Associated risk factors for injury included: high physical job demands, psychosocial factors, effort-reward imbalance, lack of career opportunities, increased age, and decreased education levels.
Conclusion: Current evidence shows that the back, neck, and shoulder are the main musculoskeletal complaints of workers in the aged care sector. However specific diagnoses of these injuries have not been investigated. Further research should focus on quantifying specific disorders, determining risk factors, and developing prevention strategies.
Singapore faces a rapidly aging population. By 2030, 19% of her population will be aged 65 years and above. Other Asian countries face similar problems, with South Korea having the fastest aging population worldwide, followed by China and Thailand. With Singapore possessing an advanced aging population, its policy provides a useful case study of eldercare to cater to evolving population demographics. This article will focus specifically on nursing homes and analyze current policies toward them, synthesize recommendations to improve long term care, and justify a paradigm shift toward more holistic, humanistic, and multidimensional care.
Migrant care workers make a substantial contribution to older adult care in Ireland and the United Kingdom (UK). However, little is known about the relational aspects of care involving migrant care workers and older people. Given that the care relationship is closely linked to quality of care, and that the Irish and UK sectors are increasingly restricted by economic austerity measures, this lack of information is a concern for care practice and policy. Our paper explores the relationship between migrant care workers and older people in Ireland and the UK and draws on data collected in both countries, including focus groups with older people (N = 41), interviews with migrant care workers (N = 90) and data from a survey of and interviews with employers. The findings illustrate the complexity of the migrant care worker–older person relationship; the prevalence of need orientated, friendship and familial-like, reciprocal, and discriminatory interlinking themes; and the role of individual, structural and temporal factors in shaping these relationships.
This study aimed to investigate the relationship between levels of challenging behaviour in older adults living in residential settings, the degree of staff support and the psychological wellbeing of staff. Fifty-one staff working in mental health and 45 staff working in nursing home settings rated residents on the frequency of 25 challenging behaviours, and completed measures of staff support and psychological wellbeing. Staff in the mental health settings had a higher level of perceived staff support than those working in the nursing home settings. Psychological wellbeing in staff was found to be positively correlated to the degree of staff support perceived by staff, and not related to levels of resident challenging behaviour. The implications of these findings, including the need to adopt a more psychological framework to care provision in nursing home settings, are discussed.
Emotion work (emotional labour) is defined as emotional regulation required to display organizationally desired emotions by the employees. It has received increased attention because it is relevant in the service industry where social interactions with customers, clients, or patients are a significant part of the job. Empirical studies found equivocal effects on psychological well-being which indicates that emotion work is a multidimensional construct with dimensions having positive and negative health effects. In the present studies, the following aspects of emotion work were differentiated: emotional regulation requirements: (1) the requirement to display positive emotions; (2) the requirement to display negative emotions, (3) the requirement to be sensitive to clients' emotions; (4) emotional dissonance: the expression of emotions that are not felt. Analyses were based on a representative sample (N = 184) of service workers and another sample of service workers (N = 1158) consisting of call centre agents, hotel and bank employees, and kindergarten teachers. The data showed that emotional dissonance was the stressful aspect of emotion work, whereas the display of positive emotions and sensitivity requirements also had positive effects on personal accomplishment. The requirement to express negative emotions had little effect on burnout. Neuroticism had little impact on the relations between emotion work and burnout.
SUMMARY This paper provides a critical look at the challenges facing the field of health promotion. Pointing to the persistence of the disease orientation and the limits of risk factor approaches for conceptualizing and conduct- ing research on health, the salutogenic orientation is presented as a more viable paradigm for health promo- tion research and practice. The Sense of Coherence framework is offered as a useful theory for taking a salutogenic approach to health research.
Most professional health publications and presentations are not about health, but about how to avoid, prevent, or treat disease or infirmity. Better health cannot be attained by simply avoiding, preventing, or treating problems. Health efforts, therefore, should be directed toward creating physical, mental, and social wellbeing. To guide these efforts, salutogenesis, a theoretical framework about the origins or creation of health, is needed to complement the traditional pathogenesis framework that focuses on the origins and causes of disease. Salutogenic strategies are necessary to help health professionals promote positive health enhancement by making their practices about health.
Nursing home reform has recently targeted workplace culture change with initiatives that are thought to empower employees. Most research has explored outcomes of these strategies with little focus on certified nursing assistants' (CNAs) perceptions of empowerment. The purpose of this study was to evaluate CNAs' experience of empowerment (psychological empowerment) and their perceptions of the facility's ability to serve the needs of the residents (service quality). Results showed that CNAs' perceptions of empowerment and facility-level service quality were strongly related to job satisfaction, accounting for almost 46% of the variance in job satisfaction.
Although it has often been presumed that jobs involving “people work” (e.g., nurses, service workers) are emotionally taxing (Maslach & Jackson, 1982), seldom is the emotional component of these jobs explicitly studied. The current study compared two perspectives of emotional labor as predictors of burnout beyond the effects of negative affectivity: job-focused emotional labor (work demands regarding emotion expression) and employee-focused emotional labor (regulation of feelings and emotional expression). Significant differences existed in the emotional demands reported by five occupational groupings. The use of surface-level emotional labor, or faking, predicted depersonalization beyond the work demands. Perceiving the demand to display positive emotions and using deep-level regulation were associated with a heightened sense of personal accomplishment, suggesting positive benefits to this aspect of work. These findings suggest new antecedents of employee burnout and clarify the emotional labor literature by comparing different conceptualizations of this concept.
To contrast the level of anxiety and depression reported by older Australians providing assistance to someone who is ill, disabled or elderly with that of non-caregivers; and to identify secondary stressors and mediating factors which explain caregivers' poorer mental health.
Analysis of data from wave 2 of the PATH Through Life Study, a community survey of 2,222 adults aged 64-69 years conducted in Canberra and Queanbeyan, Australia. Mental health was assessed using the Goldberg depression and anxiety scales. Analyses focused on those who identified themselves as a primary carer and/or reported providing care for more than 5 hours per week. Analyses evaluated whether the association between caregiver status and mental health was mediated by financial factors, role strain, physical health, and social support and conflict with family and friends after adjusting for demographics.
Caregivers reported significantly poorer mental health than non-caregivers, and also reported poorer physical health, greater financial stress, greater responsibility for household tasks, and more conflict and less social support from their family and spouse. Mediation analysis showed that the poorer mental health of caregivers reflected elevated rates of their own physical impairment, a lack of social support and greater conflict.
The relationship between caregiving and mental health was largely explained by social support and levels of conflict within the family, which are modifiable and potentially amenable to change through policy and intervention. Research such as this can assist the development of appropriate interventions to improve the circumstances of informal caregivers in Australia.
To identify supervisory factors related to job satisfaction among certified nursing assistants (CNAs). Although this topic has been studied at the facility and state levels, it has not previously been addressed in a nationally representative sample.
Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey, conducted by the National Center for Health Statistics.
Nationally representative sample of nursing homes (n = 790).
Eight randomly selected CNAs from each nursing home, 4 who had been at that job for less than 1 year and 4 at the job for a year or more (n = 3011). Analysis was limited to 2897 individuals working at the same facility when interviewed.
Job satisfaction was measured by a 6-item score addressing workplace morale, challenging work, benefits, salary or wages, learning new skills, and overall satisfaction. Characteristics of the work environment included supervisor behavior, time pressures, organizational climate, perception that the CNA's work was valued, and whether the CNA principally cared for the same residents.
In adjusted analysis, organizational climate, supervisor behavior, sufficient time for tasks, and being valued were positively associated with job satisfaction, as were hourly earnings.
Clear communication from supervisors and evidence that the CNA function is valued were associated with job satisfaction. Specific strategies, such as merit raises and job design, may increase job satisfaction.
This research explored perceived barriers to job performance among a national sample of nursing assistants (NAs). Specific objectives were (1) to clarify which of the problems identified by previous research are most troublesome for NAs, (2) to develop a reliable quantitative measure of perceived barriers to job performance, and (3) to test construct validity of the measure vis-à-vis work-related psychological empowerment and job satisfaction.
Nursing assistants attending the 2006 national conference of the National Association of Health Care Assistants completed a paper-and-pencil survey including 33 barriers to job performance and standardized measures of empowerment and job satisfaction. The barriers were also rated by a small sample of NAs at a single Georgia nursing home.
Factor analysis of barriers items yielded a 30-item Nursing Assistants Barriers Scale (NABS) comprising 6 subscales: Teamwork, Exclusion, Respect, Workload, Work Stress, and New NAs. Lack of teamwork and exclusion from communication processes were rated as most problematic by both samples. The 6 NABS subscales were significantly and independently associated with empowerment and satisfaction; different barriers predicted the 2 constructs.
This study is a first step toward quantitative assessment of NAs' perceptions of barriers to doing their jobs. Primary limitations are the select sample and use of a job satisfaction measure that may have artificially inflated correlations with the NABS. Nonetheless, results confirm the validity of the new scale as an operationalization of the barriers construct.
The concept of barriers to job performance is a unique construct from work empowerment and satisfaction with one's job. Nursing assistants clearly differentiate various barriers, converging on workload and lack of teamwork as most problematic. Further work is needed to substantiate validity and reliability of the NABS, particularly with respect to NAs' actual job performance, intent to stay on the job versus leave, absenteeism, and turnover.
Increasing numbers of patients with cancer are being cared for by home caregivers. The primary purpose of this methodologic, correlational study was to identify, categorize, and assess the importance of needs expressed by 492 home caregivers and to determine how well these needs were satisfied. Caregivers surveyed were selected from the records of two nonprofit community cancer agencies and two hospital outpatient oncology clinics in the Midwest. These individuals were identified by at-home patients with cancer as unpaid people who helped with physical care or coping with the disease process. Caregiver characteristics and patient activity were examined to determine their relationships to caregiver needs, and needs were examined over time. The 90-item Home Caregiver Need Survey used in this study was developed by the author in 1989 and demonstrated internal consistency, reliability, and construct validity. Using factor analysis, six need categories were identified: psychological, informational, patient care, personal, spiritual, and household. Caregivers' greatest needs were informational and psychological. Significant correlations between certain caregiver characteristics and caregiver needs and between caregiver needs and patients' activity levels were found. Both the importance and satisfying of needs changed over time. Findings indicate the urgent need for nurses, who usually provide support for caregivers, to establish specific programs and services to meet the identified and unmet informational and psychological needs of caregivers of at-home patients with cancer. Frequent reassessment of caregiver needs seems to be indicated.
The purpose of this paper is to examine the effects of working in clients' homes on the mental health and well-being of visiting home care workers. This paper reports the results of a survey of 674 visiting staff from three non-profit home care agencies in a medium-sized city in Ontario, Canada. Survey results are also complimented by data from 9 focus groups with 50 employees. For purposes of this study, home care workers include visiting therapists, nurses, and home support workers. Mental health and well-being is measured by three dependent variables: stress; job stress; and intrinsic job satisfaction. Multiple least squared regression analyses show several structural, emotional, physical, and organizational working conditions associated with the health and well-being of visiting home care workers. Overall, results show that workload, difficult clients, clients who take advantage of workers, sexual harassment, safety hazards, a repetitious job, and work-related injuries are associated with poorer health. Being fairly paid, having good benefits, emotional labour, organizational support, control over work, and peer support are associated with better health. Results suggest that policy change is needed to encourage healthier work environments for employees who work in clients' homes.
Leadership and clinical staff were surveyed to explore communication and leadership in nursing homes. Registered nurses and other professionals perceived communication as better than their nursing colleagues did. Overall, results suggest all factors of communication could improve. In terms of leadership, licensed practical nurses perceived less clarity of expectations, encouragement of initiative, and support than other groups. The study provides insight into what is organizationally necessary to improve quality of care in nursing homes.
The ageing of the population in the US and elsewhere raises important questions about who will provide long-term care for elderly and disabled people. Current projections indicate that home care workers--most of whom are unskilled, untrained and underpaid--will increasingly absorb responsibility for care. While research to date confirms the demanding aspects of the work and the need for improved working conditions, little is known about how home care workers themselves experience and negotiate their labour on a daily basis. This paper attempts to address this gap by examining how home care workers assign meaning to their 'dirty work'. Qualitative interviews suggest that home care workers have a conflicted, often contradictory, relationship to their labour. Workers identify constraints that compromise their ability to do a good job or to experience their work as meaningful, but they also report several rewards that come from caring for dependent adults. I suggest workers draw dignity from these rewards, especially workers who enter home care after fleeing an alienating service job, within or outside the healthcare industry.
There have been few longitudinal studies investigating the impact of coping on psychological morbidity in caregivers of people with dementia. Findings have been inconsistent and little attention has been paid to anxiety in caregivers. We explored the hypothesis that the relationship between caregiver burden and anxiety and depression is mediated by coping style.
As part of the LASER-AD study, 93 (73.8%) people with Alzheimer's disease and their family caregivers recruited at baseline were re-interviewed 1 year later. Sampling aimed to ensure that the participants were representative of people living in the UK with Alzheimer's disease in terms of dementia severity, gender and care setting. We used the Hospital Anxiety and Depression Scale, the Zarit Burden scale and the Brief COPE to measure coping strategies.
Using fewer emotion-focused strategies and more problem-focused strategies (but not dysfunctional strategies) mediated the relationship between caregiver burden and anxiety a year later, after controlling for potential confounders, in a well-fitting structural equation model (chi(2)=0.93, df=3, p=0.82; NFI=1.0, RFI=0.97, IFI=1.0, TLI=1.1, RMSEA=0.0). Using fewer emotion focused strategies also predicted higher psychological morbidity in general. The hypothesised relationship was not proved for depression.
Using emotion-focussed coping strategies in response to caregiver burden seemed to protect caregivers from developing higher anxiety levels a year later; however using problem-focussed strategies did not. Our results suggest that a psychological intervention package to emphasise emotion-focused coping may be a rational approach to reduce anxiety in dementia caregivers. Studies are needed to test such interventions.
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