Individual and organisational factors in the psychosocial work environment are associated with home care staffs' job strain: a Swedish cross-sectional study.

BACKGROUND: Home care staff (HCS) provide essential service to enable older adults to age in place. However, unreasonable demands in the work environment to deliver a safe, effective service with high quality has a negative impact on the individual employee's well-being and the care provided to the older adults. The psychosocial work environment is associated with employees´ well-being, although, knowledge regarding which individual and organisational factors that contribute to job strain for HCS is limited. These factors need to be identified to develop targeted interventions and create sustainable work situations for HCS. This study aimed to explore how HCS´s perceived job strain is associated with, and to what extent can be explained by, individual and organisational factors of the psychosocial work environment and psychosomatic health. METHOD: An explorative cross-sectional questionnaire survey design was used in a large Swedish county. Five home care agencies with a total of 481 HCS were asked to respond to a questionnaire regarding their perceived level of job strain (Strain in Dementia Care Scale), psychosocial work environment (QPSNordic34+), and psychosomatic health (Satisfaction with Work Questionnaire). Multiple linear regression (MLR) analyses were conducted to explore the association between job strain and individual and organisational factors. RESULTS: In total, 226 (46%) HCS responded to the questionnaire. Both individual and organisational factors were significant predictors of job strain and explained a variance ranging between 39 to 51% (p = 0.001). The organisational factor job demand and the individual factor feeling worried and restless was most frequently represented in these MRL models. A higher job strain was also associated with adverse outcomes regarding leadership, organisational culture and climate, and control at work. CONCLUSION: This study indicates that there is an intertwined complexity of individual and organisational factors that are associated with the HCS´s perception of job strain. Implementation of new multidimensional work strategies, such as a reablement approach, could support the development of efficient strategies for HCS and reduce the level of job strain. Policy changes for the provision of home care are also needed to support the development of a sustainable and healthy psychosocial work environment.

Putting culture in the curriculum: a European project.

The purpose of this paper is to describe the rationale for and the method of designing a framework for a European curriculum to promote intercultural competence in health care students. The background relating to the migration of people into and across Europe is cited as the factor driving the need for such a project. The project group emerged from the European organisation known as COHEHRE (Consortium of Higher Education Institutes in Health and Rehabilitation in Europe). Composed of a group of nurse educators from 5 European countries it charts the process which led them to create a curriculum framework. The completed work is available in the form of a CD-ROM. The paper describes the steps taken to reach the project outcomes over 4 years. The methods of dissemination of the project outcomes are included. The discussion considers the journey of the group towards the outcomes of the project and identifies the need to discover how effective the framework is in achieving the aims of the group. In conclusion it articulates the hope that this work will improve the care which is shown to all recipients of health care whatever their cultural background.

European higher health care education curriculum: development of a cultural framework.

This article concerns the European Curriculum in Cultural Care Project (2005-2009), which aimed at developing a curriculum framework for the enhancement of cultural competence in European health care education. The project was initiated and supported by the Consortium of Institutes in Higher Education in Health and Rehabilitation, whose goal is to nurture educational development and networking among member institutions. The framework is the result of a collaborative endeavor by nine nurse educators from five different European countries. The production of the framework will be described in accordance with the following tenets: developing cultural competence is a continuing process, cultural competence is based on sensitivity toward others, and cultural competence is a process of progressive inquiry. Critique concerning the framework will be presented.

Psychometric evaluation of the Swedish adaptation of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals--Revised (IAPCC-R).

The purpose of this study was to describe the translation, adaption, and psychometric evaluation process in relation to validity and reliability of the Swedish version of the instrument, Inventory for Assessing The Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R) following the translation, adaptation, and psychometric evaluation process. Validity tests were conducted on the response processes (N = 15), the content (N = 7), and the internal structure of the instrument (N = 334). Reliability (alpha = .65 for the total scale varying between -.01 and .65 for the different subscales) was evaluated in terms of internal consistency. Results indicated weak validity and reliability though it is difficult to conclude whether this is related to adaptation issues or the original construction.The testing of the response process identified problems in relation to respondents' conceptualization of cultural competence. The test of the content identified a weak correspondence between the items and the underlying model. In addition, a confirmatory factor analysis did not confirm the proposed structure of the instrument. This study concludes that this instrument is not valid and reliable for use with a Swedish population of practicing nurses or nursing students.