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Work in eldercare - staying or leaving: Caregivers' experiences of work and support during organizational changes
Karolinska institutet.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to reveal nursing home (NH) caregivers’ work ex-periences when receiving support through education and clinical supervision over a two-year period, while the workplace was undergoing organizational changes. The studies (I-IV) com-bine qualitative and quantitative methods in a longitudinal two-year follow-up project in three Swedish NHs (NH I - III), in which support was given to the staff at NH I-II. NH III was in-cluded as a comparison. The thesis is based on interviews (I-IV) and self-assessment ques-tionnaires (I), which were conducted at three occasions: at start, after 12 and 24 months at the respective NHs. As a result of political decisions, NH I was informed of organizational changes and pending financial cutbacks shortly after opening. The other NHs were informed at around 12 months. The numbers of caregivers willing to participate at start were 32, 21 and 22 at the respective NHs. No new participants were included to replace dropouts. Descriptive statistics (I) and qualitative content analyses (I-IV) were used. Study I focused on the organ-izational climate and the prevalence of burnout symptoms in the three NHs. The result from NH I revealed an improvement over time as opposed to NH II, which showed negative pro-gression at 12 months, despite support. This corresponded to the time at which they received information about financial cutbacks. The improvement based on the interviews at NH I was not as distinct as that based on the self-assessment scores. The support given seemed to have helped the caregivers at NH I, but was not able to alter the situation at NH II. The develop-ment based on self-assessments at NH III was more constant throughout the study. Results from interviews at NH II and III were more in accordance with the scores. In Study II, the caregivers’ work experiences at NH II, while receiving support through education and clinical supervision, showed that they valued the caring milieu and their own knowledge. The value of knowledge was related to their different backgrounds and to the knowledge gained through the support, and it seemed to be one factor underlying participants’ continued willingness to stay. In Study III, caregivers’ experiences and reflections on working at NH III, while under threat of organizational changes and termination notice, showed a transition from ‘having a professional identity and self-confidence’ to ‘being a professional in a threatening situation caused by someone else’. Finally they were ‘struggling to adapt to a changed working envi-ronment as a person and a professional’. The caregivers experienced a loss of pride and satis-faction. Included in Study II and III were interviews from those caregivers who had been interviewed on all three occasions. Study IV focused on what had caused caregivers at the three NHs to decide to leave their employment during the study period. Caregivers’ decisions to leave work could be encompassed in one main category: ‘Unmet expectations’. Their ex-periences were lack of encouragement, trust and professional development. Also reported were feelings of insecurity, different opinions on the care delivered, being disregarded and betrayed, followed by thoughts of leaving work and pursing other opportunities. It can be concluded that the changes at all three NHs seemed to have over-shadowed attempts to im-prove working conditions. Successful changes require a vision that justifies them. High-level decision-makers and managers ought to be conscious of the factors that facilitate or impede similar transitions. They should also focus on supporting caregivers during change processes, as the literature shows a risk for decreasing quality of care.

Place, publisher, year, edition, pages
Stockholm: Karolinska institutet , 2008. , 51 p.
Keyword [en]
Nursing home, Caregivers’ experiences and expectations, Organizational climate, Burnout, Education and clinical supervision, Cutbacks and organizational changes, Termination notice, Transition, Nursing workforce
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:esh:diva-5704Libris ID: 10877376ISBN: 978-91-7409-049-9 (print)OAI: oai:DiVA.org:esh-5704DiVA: diva2:1065776
Public defence
2008-06-11, Föreläsningssal Po-4-221, Alfred Nobels Allé 12, Karolinska universitetssjukhuset, Huddinge, 13:00
Available from: 2008-06-18 Created: 2017-01-16 Last updated: 2017-01-17
List of papers
1. Consequences of working in elder care during changes and cutbacks in the organisation while education and clinical supervision was provided: A mixed methods study
Open this publication in new window or tab >>Consequences of working in elder care during changes and cutbacks in the organisation while education and clinical supervision was provided: A mixed methods study
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2015 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 5, no 9, 813-827 p.Article in journal (Refereed) Published
Abstract [en]

Background: Reorganization and downsizing can disrupt a competent staff and conflicts can arise between what the employee is being asked to do and their knowledge and competences. Reduced job satisfaction among nursing home staff with increased workload and strain can occur. Aim and Objectives: The aim was to investigate the organizational climate and prevalence of burnout symptoms among caregivers over time in three Swedish nursing homes (NH I-III) undergoing organizational changes, while education and clinical supervision were provided. Design: The study design combines qualitative and quantitative methods in a longitudinal two-year follow-up project in NH I-III. Methods: Support through education and clinical supervision was provided for caregivers only at NH I and NH II. At NH I-III caregiver self-assessments and interviews were completed and analysed three different times. Results: NH I revealed improvement and increased innovation over time, while NH II showed a decline with no ability to implement new knowledge. NH III retained a more status quo. Conclusions: Organizational changes and cutbacks, occurring at different times, appeared to cause major stress and frustration among the three personnel groups. They felt guilty about not meeting their perceived obligations, seemed to have lost pride in their work but kept struggling. The changes seemed to over-shadow attempts to improve working conditions through education and clinical supervision initially. Implications for practice: It will be important to learn from reorganizations and the consequences they will have for the staff and quality of care. Important topics for future research are to study financial cutbacks and changes in organizational processes in care of older people to be able to develop a more person centered care for older people.

Keyword
Nursing Home, Organizational Climate and Burnout, Education and Clinical Supervision, Cutbacks and Organizational Changes
National Category
Other Medical Sciences not elsewhere specified Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:esh:diva-5654 (URN)10.4236/ojn.2015.59086 (DOI)
Note

As submitted manuscript in dissertation with title: "Organizational climate and burnout in relation to changes in organization - caregivers self-assessments and experiences at nursing homes."

Available from: 2016-12-19 Created: 2016-12-19 Last updated: 2017-01-17Bibliographically approved
2. Despite shattered expectations a willingness to care for elders remains with education and clinical supervision
Open this publication in new window or tab >>Despite shattered expectations a willingness to care for elders remains with education and clinical supervision
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2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 3, 379-389 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to describe nursing home (NH) caregivers' work experiences while receiving education and clinical supervision for 2 years. Working in elder care seems to be losing its attraction especially with organizational changes, cutbacks and changes in work place conditions. Clinical supervision has been reported to increase job satisfaction and creativity. Semi-structured interviews from caregivers working at an NH in Sweden were conducted, at the start and again at 12 and 24 months. At about 12 months the caregivers were informed of planned cutbacks. Content analysis was the method used to analyse the interviews from seven caregivers who participated throughout the entire period. Findings show that the value of a caring milieu was one category generated by the subcategories: experiences related to work activities and changes, and experiences related to relationships. The value of knowledge was the other category that was influenced by the experiences related to the different backgrounds and the experiences related to increased knowledge gained from the support through education and clinical supervision. The categories contained positive as well as negative influences on care. The initial focus on practical duties associated with the opening of the NH shifted towards caregiver activities with the elders they spoke warmly about. After 2 years the caregivers' willingness to care continued despite their disappointment in the worsened working conditions. The main theme that resulted was: Despite shattered expectations a willingness to care for elders remained. Continued education and clinical supervision seems to be one factor behind the retained willingness. These findings demonstrate that support and caregiver involvement in educational programmes are important during times of change and when disappointments arise in the workplace.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-56 (URN)10.1111/j.1471-6712.2007.00478.x (DOI)17727551 (PubMedID)
Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2017-01-17Bibliographically approved
3. Struggling to adapt: caring for older persons while under threat of organizational change and termination notice
Open this publication in new window or tab >>Struggling to adapt: caring for older persons while under threat of organizational change and termination notice
2009 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 16, no 1, 82-91 p.Article in journal (Refereed) Published
Abstract [en]

Organizational changes are common in elder care today. Such changes affect caregivers, who are essential to providing good quality care. The aim of the present study was to illuminate caregivers' experiences of working in elder care while under threat of organizational change and termination notice. Qualitative content analysis was used to examine interview data from 11 caregivers. Interviews were conducted at three occasions during a two-year period. The findings show a transition in their experiences from 'having a professional identity and self-confidence', to 'being a professional in a threatening situation caused by someone else' and to 'struggling to adapt to a changed working environment as a person and a professional'. The caregivers experienced a loss of pride and satisfaction. Previous literature indicates that this may have consequences for the quality of care and that employees may be at risk of negative health effects. However, the caregivers continued to struggle, doing their best to complete their duties. The study has implications for high-level decision-makers, managers and caregivers in similar work-life situations in that it deals with factors that facilitate or impede similar transitions.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-134 (URN)10.1111/j.1440-1800.2009.00434.x (DOI)19228307 (PubMedID)
Note

As submitted manuscript in dissertation.

Available from: 2010-05-18 Created: 2010-05-18 Last updated: 2017-01-17Bibliographically approved
4. Unmet expectations: why nursing home staff leave care work
Open this publication in new window or tab >>Unmet expectations: why nursing home staff leave care work
2008 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 3, no 1, 55-62 p.Article in journal (Refereed) Published
Abstract [en]

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 performed 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 of 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 pursuing other opportunities.

Conclusions. The main findings indicated that organizational work pressure with information 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.

Keyword
Expectations, Leave employment, Nursing homes, Nursing workforce
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:esh:diva-5705 (URN)10.1111/j.1748-3743.2007.00101.x (DOI)20925890 (PubMedID)
Available from: 2008-06-18 Created: 2017-01-16 Last updated: 2017-01-17Bibliographically approved

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