Collaboration among eldercare workers: barriers, facilitators and supporting processes.

To retain qualified care workers and to ensure high-quality care for residents in eldercare homes, well-functioning collaboration among care workers is pivotal. This study aims to identify barriers and facilitators of collaboration among eldercare workers and to describe the processes leading to well-functioning collaboration. We collected focus group data from 33 eldercare workers from seven Danish eldercare homes. We found that collaboration was hampered by a number of formal and informal divisions among care workers. To ensure well-functioning collaboration, social and professional relations among care workers needed to be dealt with actively by care workers and by managers. The analysis showed that managers are essential for creating a well-functioning framework around the collaboration between care workers by providing guidelines and procedures for working across various divisions, by being attentive to care workers and taking decisive action when needed and by dealing with conflicts in the workgroups.

Is the association between high strain work and depressive symptoms modified by private life social support: a cohort study of 1,074 Danish employees?

BACKGROUND: Previous studies have shown that psychosocial working conditions characterized by high psychological demands and low decision latitude (i.e., high strain work) are associated with increased risk of depressive symptoms. Little is known, however, concerning how this association may be modified by factors outside the working environment. This article examines the modifying role of private life social support in the relation between high strain work and the development of severe depressive symptoms. METHODS: Data were questionnaire-based, collected from a cross-occupational sample of 1,074 Danish employees. At baseline, all participants were free of severe depressive symptoms, measured by the Mental Health Inventory. High strain work was defined by the combination of high psychological demands at work and low control, measured with multi-dimensional scales. Private life social support was operationalized as the number of life domains with confidants and dichotomized as low (0-1 domains) or high (2 or more domains). Using logistic regression we examined the risk of onset of severe depressive symptoms, adjusting for sex, age, occupational position, and prior depressive symptoms. RESULTS: Separately, neither high strain work nor low private life social support statistically significantly predicted depressive symptoms. However, participants with joint exposure to high strain work and low private life social support had an Odds ratio (OR) for severe depressive symptoms of 3.41 (95% CI: 1.36-8.58), compared to participants with no work strain and high private life social support. There was no increased risk for participants with high strain work and high private life social support (OR = 1.32, 95% CI: 0.65-2.68). The interaction term for departure from additivity was, however, not statistically significant (p = 0.18). CONCLUSIONS: Our findings suggest that high strain work may increase risk of depressive symptoms in individuals with low private life social support, although the effect-modification was statistically non-significant. Larger studies are needed to further establish the role of private life social support in the relation between high strain work and depression.

Do self-reported psychosocial working conditions predict low back pain after adjustment for both physical work load and depressive symptoms? A prospective study among female eldercare workers.

OBJECTIVES: To investigate whether psychosocial working conditions predict the development of low back pain (LBP) in female eldercare workers while adjusting for physical workload and depressive symptoms. METHODS: We investigated risk for developing LBP for between 1 and 30 days in the past year and developing LBP for more than 30 days in the past year at follow-up in 1537 female eldercare workers with no LBP in the year before baseline. Data were analysed using logistic regression analysis adjusted for sociodemographic variables, health behaviours, physical workload and depressive symptoms at baseline. Follow-up ranged from 18 to 22 months. RESULTS: High emotional demands, high and medium role conflicts and low influence predicted risk for reporting LBP for between 1 and 30 days in the past year at follow-up after adjustment for sociodemographics, health behaviours and physical workload. All associations became statistically non-significant when adjusted for depressive symptoms. Low and medium influence at work and high emotional demands predicted risk of reporting LBP for more than 30 days in the past year at follow-up, after adjustment for sociodemographics, health behaviours and physical workload. For employees with low (OR 4.16; 95% CI 1.36 to 12.75) and medium (OR 3.93; 95% CI 1.37 to 11.22) influence, this risk remained statistically significant after adjustment for depressive symptoms. CONCLUSIONS: Most psychosocial working conditions in this study were no longer associated with risk of LBP after adjustment for depressive symptoms. However, low and medium influence at work predicted risk for LBP for more than 30 days after adjustment for both physical workload and depressive symptoms.

Danish Observational Study of Eldercare work and musculoskeletal disorderS (DOSES): a prospective study at 20 nursing homes in Denmark.

PURPOSE: Musculoskeletal disorders (MSDs), sickness absence and premature retirement are highly prevalent among eldercare workers. We conducted a prospective observational workplace study with the main purpose to investigate longitudinal associations between physical and psychosocial working conditions and occurrence of MSD and its consequences (pain-related interference with daily work activities and sickness absence) among Danish eldercare workers. PARTICIPANTS: At 20 Danish nursing homes, a total of 941 eldercare workers employed in day and evening shifts were invited to the study. Of those, 553 participated in the baseline measurements, and 441 completed the total period of 12 months follow-up. FINDINGS TO DATE: Data were collected from September 2013 to January 2016. Physical and psychosocial working conditions were assessed with multiple methods (observations, accelerometer measurements and work schedules), and multiple levels of information (nursing home, ward, resident and eldercare worker) were incorporated in the data collection. MSD and the consequences hereof were assessed monthly during a 1-year follow-up. Study participants and non-participants were comparable on most of the 27 sociodemographic, health and working condition characteristics at baseline. The exceptions were higher neck-shoulder pain intensity, less sickness absence, more exposure to negative behaviour from residents and a higher percentage of working day shifts and fewer evening shifts among participants compared with non-participants. FUTURE PLANS: The first publications will report on the associations of physical and psychosocial working conditions with occurrence of MSD and its consequences. In addition, the cohort gives the opportunity to investigate the importance of organisational, management and team factors for distribution of physical work demands and development of MSD among the workers. This will provide important knowledge for future workplace interventions to reduce MSD and sickness absence.

Emotion work within eldercare and depressive symptoms: A cross-sectional multi-level study assessing the association between externally observed emotion work and self-reported depressive symptoms among Danish eldercare workers.

BACKGROUND: Danish professional caregivers have high rates of depressive symptoms. One proposed cause is exposure to emotion work. However, emotion work is usually measured by self-report which may bias results. OBJECTIVES: The objective of this study was to examine the association of emotion work, externally observed at the workplace, with self-reported depressive symptoms of professional caregivers. DESIGN AND DATA SOURCES: The study was a cross-sectional observational study. Data was collected by 9 observers who assessed emotion work stressors and emotion work resources in 124 individual professional caregivers working in 56 work units across 10 eldercare homes. Emotion work stressors were defined as i) barriers for empathetic care, ii) taxing aggressive events, and iii) taxing non-aggressive events. Emotion work resources were defined as i) meaningful events, and ii) social interactions between professional caregivers and residents. Depressive symptoms were measured by a questionnaire sent to all professional caregivers at the 10 eldercare homes. We constructed two samples for analysis: a) a sample of 95 directly observed professional caregivers with full information on covariates, and b) a sample of 205 observed and non-observed professional caregivers with full information on covariates working in one of the 56 observed work units. METHODS: Using multilevel regression models we analysed associations of individual and work unit averaged levels of emotion work with depressive symptoms among professional caregivers. RESULTS: None of the three emotion work stressors were associated with depressive symptoms. Of the two emotion work resources, a high amount of social interactions between professional caregivers and residents were, contrary to expectations, related to higher levels of depressive symptoms at both the individual level and the work unit averaged level. CONCLUSIONS: The unexpected association between social interactions and depressive symptoms need to be replicated in future studies. These future studies should also investigate whether the association of social interactions and level of depressive symptoms depends on the content of the interactions between professional caregivers and residents.

A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark.

OBJECTIVES: Eldercare workers in Denmark have a higher prevalence of poor psychological health than other occupational groups. We examined the association between working conditions assessed by trained observers and depressive symptoms assessed by self-report in a study of female Danish eldercare workers. METHODS: Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work unit averaged working conditions with depressive symptoms in a sample of 95 individually observed eldercare workers. Further, we examined the association of work unit averaged working conditions with depressive symptoms in a sample of 205 care workers, including both observed and non-observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. RESULTS: Higher levels of regulation requirements were associated with lower depressive symptoms at the individual level (p=0.04), but not at the workplace level. Barriers were not associated with depressive symptoms at the individual level. At the workplace level, a higher number of qualitatively different barriers (p=0.04) and a higher number of barriers for equipment use (p=0.03) were associated with lower levels of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model. CONCLUSIONS: Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both individual and workplace levels of working conditions.