Professional knowledge development and evidence-based practice in confusing vs. supportive work organizations: A grounded theory situational analysis of Swedish elderly care.

BACKGROUND: This article focuses on knowledge development and health professionals' opportunities to use evidence-based practice (EBP). We studied registered physiotherapists (PT), occupational therapists (OT) and nurses (RN) in Swedish elderly-care institutions, a sector known for high turnover and shortages of competent staff. OBJECTIVE: To examine the perspectives of healthcare providers on professional knowledge development and EBP in their organization. METHODS: We conducted on-site qualitative interviews with a purposive sample of PTs, OTs and RNs, in six elderly care institutions. Situational analysis was used to analyze the material. RESULTS: Three discursive professional positions were found: 1) Professional ambition in confusing work organization; 2) Professional ambition in a knowledge-promoting work organization; and 3) Professional indifference with few aspirations for knowledge development. Professional aspirations toward knowledge development were high in two of these positions, whereas the third represents a slightly different approach with fewer aspirations for knowledge development. Linked to these professional approaches to knowledge development is a continuum of aggravating or facilitating factors within the work organization, including varying degrees of support from leadership of the organization, as well as few opportunities for rewards. DISCUSSION AND CONCLUSIONS: It is concluded that elderly care needs to develop strategies for evidence-based practice in order for the sector to become a sustainable arena for health professionals' career development, and in order to improve the quality of care for the elderly.

Unequal physical activity among children with cerebral palsy in Sweden-A national registry study.

AIM: To examine the extent to which sex, country of birth, and functional aspects influence participation in physical education and physical leisure activity among children with cerebral palsy (CP) in Sweden. METHODS: This national cross-sectional registry study included children with CP aged 6 to 18 years who participated in the Swedish national quality registry, the Cerebral Palsy Follow-up Program, CPUP, in 2015. Comparisons and associations between sex, country of birth, and functional aspects and physical leisure/physical education were examined using chi-squared and multivariable logistic regression analysis. RESULTS: The study included 1935 children. Of them, 1625 (87%) reported participating in physical education and 989 (53%) reported participating in physical leisure activity. Children born in Sweden had higher odds of participating in physical education (OR: 1.99; 95% CI: 1.20-3.28) and physical leisure activity (OR: 2.51; 95% CI: 1.70-3.72) compared with children born outside Europe. Greater impairment of gross motor function was associated with lower participation levels. Boys participated slightly more frequently in leisure activities than girls. CONCLUSION: Enhancing social inclusion with regard to disability, birth country, and sex are important and achievable goals for policymakers and practitioners for promoting participation in physical activity for children and adolescents with CP.

Inequity in physiotherapeutic interventions for children with Cerebral Palsy in Sweden-A national registry study.

AIM: The aim of this study was to investigate the distribution of physiotherapeutic interventions for children with Cerebral Palsy in Sweden from an equity perspective, considering sex, country of birth and geographical region. METHOD: This national cross-sectional registry study includes children with Cerebral Palsy aged 0-18 years who participated in 2015 in the Swedish national quality registry, the Cerebral Palsy follow-up programme, CPUP. Comparisons and associations between physiotherapeutic interventions and sex, country of birth and geographical regions were conducted using chi-square and logistic regression analysis, controlling for cognitive level, level of motor function, age group and dominating symptom. RESULTS: Of the 2855 participants, 2201 (79%) had received physiotherapy. Children born in Sweden had 1.60 times higher odds (95% CI 1.10-2.33) of receiving physiotherapy compared with children born in foreign countries. Distribution of physiotherapeutic interventions differed significantly between geographical regions. No associations between sex and physiotherapeutic interventions were observed. CONCLUSION: The results of this study indicate inequity in care in Sweden towards children with Cerebral Palsy born in other counties. Further, physiotherapeutic interventions were not equally distributed in different geographical regions of Sweden. Knowledge of inequity is crucial in order to address the problem.

Employee effort - reward balance and first-level manager transformational leadership within elderly care.

BACKGROUND: Negative aspects, staff dissatisfaction and problems related to internal organisational factors of working in elderly care are well-known and documented. Much less is known about positive aspects of working in elderly care, and therefore, this study focuses on such positive factors in Swedish elderly care. We combined two theoretical models, the effort-reward imbalance model and the Transformational Leadership Style model. The aim was to estimate the potential associations between employee-perceived transformational leadership style of their managers, and employees' ratings of effort and reward within elderly care work. METHODS: The article is based on questionnaires distributed at on-site visits to registered nurses, occupational therapists, physiotherapists (high-level education) and assistant nurses (low-level education) in nine Swedish elderly care facilities. In order to grasp the positive factors of work in elderly care, we focused on balance at work, rather than imbalance. RESULTS: We found a significant association between employees' effort-reward balance at work and a transformational leadership style among managers. An association was also found between employees' level of education and their assessments of the first-level managers. CONCLUSIONS: We conclude that the first-level manager is an important actor for achieving a good workplace within elderly care, since she/he influences employees' psychosocial working environment. We also conclude that there are differences and inequalities, in terms of well-being, effort and reward at the work place, between those with academic training and those without, in that the former group to a higher degree evaluated their first-level manager to perform a transformational leadership style, which in turn is beneficial for their psychosocial work environment. Consequently, this (re)-produce inequalities in terms of well-being, effort and reward among the employees at the work place.

Team social cohesion, professionalism, and patient-centeredness: Gendered care work, with special reference to elderly care - a mixed methods study.

BACKGROUND: Healthcare organisations are facing large demands in recruiting employees with adequate competency to care for the increasing numbers of elderly. High degrees of turnover and dissatisfaction with working conditions are common. The gendered notion of care work as 'women's work', in combination with low salaries and status, may contribute to negative work experiences. There is abundant information about the negative aspects of elderly care health services, but little is known about positive aspects of this work. The study aim was to investigate work satisfaction from a gender perspective among Swedish registered nurses, physiotherapists, and occupational therapists, focusing specifically on healthcare services for the elderly. METHODS: A mixed methods approach was adopted in which we combined statistics and open-ended responses from a national survey with qualitative research interviews with healthcare professionals in elderly care organisations. The survey was administered to a random sample of 1578 registered nurses, physiotherapists, and occupational therapists. Qualitative interviews with 17 professionals were conducted in six elderly care facilities. Qualitative and quantitative content analyses, chi2 and constructivist grounded theory were used to analyse the data. RESULTS: There was a statistically significant difference in overall work satisfaction between those who worked in elderly care and those who did not (64 and 74,4% respectively, p <0.001). Nine themes were derived from open-ended responses in the questionnaire. The qualitative interviews revealed four prominent storylines: 'Team social cohesion', 'Career development and autonomy', 'Client-centeredness', and 'Invisible and ignored power structures'. CONCLUSIONS: The results show the complexity of elderly care work and describe several aspects that are important for work satisfaction among health professionals. The results reveal that work satisfaction is dependent on social interrelations and cohesion in the work team, in possibilities to use humour and to have fun together, and in the ability to work as professionals to provide client-centered elderly care. Power relations such as gendered hierarchies were less visible or even ignored aspects of work satisfaction. The storylines are clearly linked to the two central discourses of professionalism and gender equality.