Nursing staff's experience of appearance issues in various nursing situations.

BACKGROUND: Health care professionals frequently interact with unknown patients in a process involving appearance-based judgements and priority-setting, all of which has an effect on health care equality. The healthcare provider-patient interaction is also highly relevant for the awareness and support of patients' appearance concerns, with an associated possibility for improving patients' satisfaction with their appearance and health. The aim was therefore to explore nursing staff's experience of patients' appearance issues in various nursing situations, with the purpose to facilitate awareness raising and knowledge development. METHOD: A qualitative research approach with focus group interviews was chosen due to the exploratory aim of the study. Five semi-structured focus group interviews were conducted with 24 nursing staff in total (19 women and five men). The participants' ages varied (20 to 45 years) as did their professional nursing experience. The interviews lasted approximately one hour, were digitally recorded, transcribed verbatim and analysed through thematic analysis. RESULTS: The thematic analysis resulted in the two themes Patient perspective and Professional nursing role, with associated subthemes. The findings showed the importance and impact of appearance issues in nursing situations and how these are linked to the health of the patients. Some groups of patients were identified as more vulnerable than others, which was associated with health care inequalities and health disparities. Value-based strategies along with knowledge, and skills for holistic person-centred care were identified as important resources for the development of appearance-related awareness and support in various nursing situations. CONCLUSION: Strategies for improvement can be realised through the educational system for nursing staff, but mainly by using collective reflective learning forums in different workplaces. An empowerment approach is considered a useful framework for the implementation of holistic person-centred care, functioning as a resource for appearance-related awareness and support in various nursing situations. However, more research is needed on the complex and challenging phenomenon of appearance issues in nursing situations. Knowledge development related to successful person-centred strategies for appearance-related awareness and support is important, especially strategies with a salutogenic perspective.

"The importance of awareness, support and inner strength to balance everyday life" - a qualitative study about women's experiences of a workplace health promotion program in human service organizations in Sweden.

BACKGROUND: In many European countries, women have a higher sickness absence rate than men. Women also report higher levels of work-life conflict, which has a negative impact on women's self-perceived health. Interventions studies on work-life balance literature are scarce. This research adds knowledge about work-life balance by examining female employees' experiences of a newly developed intervention program, the BELE program (Balance in Everyday Life Empowerment program), aiming to enhance the work-life balance and wellbeing of female employees. METHODS: All participants in the BELE program were included in the sample (n = 55) of the study. The methods used for gathering data were focus group interviews (n = 8) and semi-structured individual interviews (n = 8). A qualitative content analysis was used for the analyses. RESULTS: The results showed that a majority of the participants experienced a process of change for enhancement of wellbeing and balance in their everyday life when taking part in the BELE program. In the analyses, three main themes emerged. Reflecting and strengthening inner resource, Trying to change everyday patterns and habits and Experiencing more balance and well-being. CONCLUSIONS: The results point out the importance of awareness and reflection on everyday life to promote work-life balance and wellbeing. The BELE program was described as a wakeup call to one's own life and as an enhancer of empowerment processes and equality in the homes. Moreover, the results showed the need for health education in the workplace focusing on both work and private life to enhance balance and wellbeing among female employees'. The findings indicate that it is important to work at individual and group levels in work-life balance interventions and not merely at the organizational level or in the workplace setting.

Appearance between professionalism and work-related stress among marketing employees.

BACKGROUND: Appearance and body language are key components of non-verbal communication and play an important role in the service and marketing sector. OBJECTIVE: The aim was to explore experiences and perceptions of appearance issues related to work among employees in the marketing sector in Sweden. METHODS: Interviews were conducted with 15 marketing and communication employees (five males, ten females), at multinational companies and a university. Thematic analyses were conducted, and content was organised in two themes with sub-themes: 1. Appearance from a resource perspective (Appearance benefits; Physical activity resources; Age benefits). 2. Appearance from a demand perspective (Adaptation to gender roles; Investment in appearance; Adaptation to situation and culture). RESULTS: The findings showed that appearance was perceived as a resource for professionalism, work engagement and career in various ways. Appearance-related issues were not considered on organisational work level, but employees perceived unspoken demands to look good and appropriate to represent the company brand. The employees spent a considerable amount of time, money, and effort on appearance. CONCLUSION: Appearance creates dualistic questions and points out several dilemmas that the individual struggle to solve, which creates stress in work. The character of unspoken demands on appearance and absent communication on organisational level make the stress-coping strategies complicated and the stress coping is mostly left for the individual to handle. A gender difference shows that compared to men, women more often experience negative stress generated by appearance-related issues in work. Education and actions at the managerial level of companies are needed.

Swedish managers' experience of yearly staff development dialogues, aiming for employee development, performance, and well-being.

BACKGROUND: Societal development and a competitive corporate climate have resulted in increased emphasis on performance management (PM) but also sustainability and health challenges in working life. Opportunities for employee well-being, development and performance are thus highly relevant for organisations and society. PM includes a manager-employee dialogue process and is identified as a complex challenge when combined with employee development and well-being. Managers have a key role in PM, and research in collaboration with practitioners in specific contexts is needed. An exploratory study, focusing on managers' experience of dialogues between managers and employees in practice, was therefore conducted in collaboration with an inter-municipal corporation company in southern Sweden. METHODS: A qualitative study with an inductive design, supported by semi-structured focus group interviews, was chosen based on the exploratory character of the study. Thirty-five managers were approached in the company and 15, of varying age and managerial experience, agreed to participate. Staff Development Dialogues (SDD) were used in the company PM model to facilitate employee development, performance, and well-being. Data was analysed using conventional qualitative content analysis to obtain new insights without using pre-set classifications. RESULTS: The analysis resulted in three categories of SDD experiences: SDD in a business context; Managers in relation to SDD; and Employees in relation to SDD. The findings revealed varying SDD experiences as well as approaches, and analytical themes were considered in relation to the organisational context and the specific SDD content and process. The study showed the importance of SDD adaptation and a well-being perspective in the dialogues was related to relational aspects and the manager-employee approach to SDDs. DISCUSSION: The findings confirm the complexity and challenges of PM including development and well-being. Adaptation to specific departments as well as employees is important, and using the same PM strategy throughout an organisation can be questioned. The identified link between a relational approach and a well-being perspective indicates a missed opportunity for systematic workplace health promotion. Strengthening the well-being perspective can, thus, improve the quality of an SDD model, which in turn can facilitate the creation of sustainable workplaces and better fulfilment of employers' health-related obligations for systematic work environment management.

Flow situations during everyday practice in a medical hospital ward. Results from a study based on experience sampling method.

BACKGROUND: Nursing is a constant balance between strain and stimulation and work and health research with a positive reference point has been recommended. A health-promoting circumstance for subjective experience is flow, which is a psychological state, when individuals concurrently experience happiness, motivation and cognitive efficiency. Flow situations can be identified through individuals' estimates of perceived challenge and skills. There is, to the best of our knowledge, no published study of flow among health care staff. The aim of this study was to identify flow-situations and study work-related activities and individual factors associated with flow situations, during everyday practice at a medical emergency ward in Sweden, in order to increase the knowledge on salutogenic health-promoting factors. METHODS: The respondents consisted of 17 assistant nurses and 14 registered nurses, who randomly and repeatedly answered a small questionnaire, through an experience sampling method, during everyday nursing practice. The study resulted in 497 observations. Flow situations were defined as an exact match between a high challenge and skill estimation and logistic regression models were used to study different variables association to flow situations. RESULTS: The health care staff spent most of its working time in individual nursing care and administrative and communicative duties. The assistant nurses were more often occupied in individual nursing care, while the registered nurses were more involved in medical care and administrative and communicative duties. The study resulted in 11.5% observations of flow situations but the relative number of flow situations varied between none to 55% among the participants. Flow situations were positively related to medical care activities and individual cognitive resources. Taking a break was also positively associated with flow situations among the assistant nurses. CONCLUSIONS: The result showed opportunities for work-related interventions, with an adherent increase in flow situations, opportunity for experience of flow and work-related health among the nursing staff in general and among the assistant nurses in particular.

The BELE program: The development of a holistic interdisciplinary health-promoting program enhancing work-life balance among female employees working in human service organizations in Sweden.

BACKGROUND: Despite an increase in work-life balance literature, the development of successful support to help employees manage their work -life balance is slow. Moreover, there are few interventions with a comprehensive approach to workplace health promotion focusing on work-life balance. OBJECTIVE: This paper aims to present the development and building blocks of a holistic interdisciplinary health-promoting program, the BELE program, to enhance female employees working in human service organizations health and well-being with a focus on work-life balance. METHODS: The planning and development of the program was done through an intervention mapping and research circles methodology. RESULTS: The planning- and development process of the program resulted in a theoretical framework, and a program structure with a program content. The intervention program was named "The Balance in Everyday Life Empowerment program" (BELE program). CONCLUSIONS: The BELE program adds to the existing body of work-life balance knowledge, so far often based on a conflict approach. Interventions focusing on a comprehensive approach to health and work-life balance with a salutogenic approach are rare. Furthermore, the integration with occupational therapy and health promotion in a workplace health promotion framework is innovative. In a previous study, the BELE program has shown that it enhances women's well-being and balance in their everyday life.

Exploring workplace related health resources from a salutogenic perspective. Results from a focus group study among healthcare workers in Sweden.

OBJECTIVE: The aim of this study was to explore healthcare workers' opinions on workplace related health resources relevant to promotion of their health. PARTICIPANTS: 16 registered nurses and 19 assistant nurses, from a medical emergency ward at a medium sized hospital in the south of Sweden, participated in the study. METHODS: Eight focus group interviews were conducted, the material was condensed and conventional qualitative content analysis was used to elicit and identify patterns in the expressed opinions of the participants. RESULTS: The analysis yielded four themes that were labelled the reward, the team, the mission and the context. An explanatory model was constructed consisting of concentric circles, with the reward at the core. The qualitative analysis also revealed two divergent patterns; some of the participants associated positive health with stability while others referred to flexibility. CONCLUSIONS: The results from this study have contributed to the body of knowledge regarding salutogenic health indicators in the field of work and health research in particular as well as in health promotion in general. The findings show that individuals can have diverse responses to any given work situation, and this should be taken into account before implementation of salutogenic health promotion programs.

Development and quality analysis of the Work Experience Measurement Scale (WEMS).

Instruments related to work are commonly illuminated from an ill-health perspective. The need for a concise and useable instrument in workplace health promotion governed the aim of this paper which is to present the development process and quality assessment of the Work Experience Measurement Scale (WEMS). A survey, using a questionnaire based on established theories regarding work and health, and a focus group study were performed in hospital settings in 2005 and 2006 respectively. A Principal Component Analysis (PCA) was used to statistically develop a model, and focus group interviews were made to compare quantitative and qualitative results for convergence and corroboration. The PCA resulted in a six factor model of dimensions containing items regarding management, reorganization, internal work experience, pressure of time, autonomy and supportive working conditions. In the analysis of the focus group study three themes appeared and their underlying content was compared to, and matched, with the dimensions of the PCA. The reliability, shown by weighted kappa values, ranged from 0.36 to 0.71, and adequate Cronbach's Alpha values of the dimensions were all above 0.7. The study validity, indicated by discriminant validity, with correlation values that ranged from 0.10 to 0.39, in relation to the content validity appeared to be good when the theoretical content of the WEMS was compared to the content of similar instruments. The WEMS presents a multidimensional picture of work experience. Its theoretical base and the psychometric properties give support for applicability and offer a possibility to measure trends in the work experience over time in health care settings. One intention of the WEMS is to stimulate the ability of organizations and the employees themselves to take action on improving their work experience. The conciseness of the instrument is intended to increase its usability.

Development and quality analysis of the Salutogenic Health Indicator Scale (SHIS).

BACKGROUND: Current health measurement instruments tend to measure aspects of ill-health rather than health in general. There is a need for a salutogenic perspective when describing health and developing a health measurement instrument. The aim of this article is to present the development process and quality assessment of a salutogenic health indicator scale. METHODS: A description of health, emanating from the concept of health, positive health and well-being, was used as a basis for the construction of the scale. The scale is a semantic differential consisting of 12 indicator items covering nine heath-related dimensions. A principal component analysis was performed, and three health indicator indexes were constructed. Correlation with self-rated health questions was investigated, weighted kappa values were calculated, and Cronbach's alpha (CA) was used to check internal consistency. RESULTS: The analysis resulted in a two-factor model, and the indexes were named intrapersonal characteristics (CA= 0.90) and interactive function (CA= 0.84), summarised into health complete (CA= 0.92). Kappa values ranged from 0.44 to 0.67, and correlations with self-rated health status were stronger than those with self-rated sick-leave. CONCLUSIONS: Our health description was characterized by complexity, but the instrument is a short salutogenic health indicator scale. The shortness increases the usability. The instrument seems to be able to offset the current problem of there being a lack of salutogenic health measurement instruments. The results indicate that further testing is justified.