Strategies to mitigate moral distress as reported by eldercare professionals.

Eldercare workers experience higher levels of moral distress than other health and social care service workers. Moral distress is a psychological response to a morally challenging event. Very little is known about moral distress in the context of eldercare and about the mechanisms of preventing or mitigating moral distress. This qualitative study was conducted as part of the "Ensuring the availability of staff and the attractiveness of the sector in eldercareservices" project in Finland in 2021. The data were from 39 semi-structured interviews. This qualitative interview data were examined using two-stage content analysis. The key finding of this study, as reported by eldercare professionals, is that strategies to mitigate moral distress can be found at all organizational levels : organizational, workplace and individual. The tools that emerged from the interviews fell into four main categories:) organizational support and education 2) peer support 3) improving self-care and competence and 4) defending patients. The main identified categories confirmed the earlier findings but the qualitative, rich research interview data provided new insights into a little-studied topic: mitigating moral distress in eldercare. The main conclusion is that, in order to mitigate moral distress, ethical competence needs to be strengthened at all organizational levels.

Effectiveness of a workshop-based intervention to reduce bullying and violence at work: A 2-year quasi-experimental intervention study.

INTRODUCTION: Bullying and violence at work are associated with reduced wellbeing of the victims, but few evidence-based interventions are available to prevent these offensive behaviours. We developed and examined the effectiveness of an intervention aimed at prevention of bullying and violence at work through modifications in psychosocial work environment. METHODS: In accordance with pre-published protocol, employees and supervisors of 12 work units in 3 cities (intervention group A: n = 315; intervention group B: n = 271) received a workshop-based intervention on organizational practices to prevent bullying and violence, including supervisor support, supervisor justice, workplace social capital, and psychological safety and were compared to a reference group (n = 2310) which did not receive the intervention. Latent change score modelling (LCSM) was used to estimate between- and within-individual differences in changes of organizational practices and prevalence of bullying and violence from baseline (2020) to follow-up (2022). RESULTS: No direct or indirect effects of intervention were observed. Of the potential mediator variables, supervisor support (B = 0.04; 95% confidence interval 0.006, 0.07) and supervisor justice (0.04; 0.01, 0.08) improved in the intervention group B between the measurements and compared to control group, but the result was not replicated in intervention group A. No changes were observed between the measurement points in bullying or violence at work. CONCLUSIONS: No intervention effects on bullying and violence at work were observed. It may be worthwhile to develop the intervention further to focus more on supervisor and co-worker relationships and on psychosocial resources of work team.

Elderly Care Practitioners' Perceptions of Moral Distress in the Work Development Discussions.

Elderly care practitioners are at specific risk of experiencing prolonged moral distress, which is associated with occupational health-related problems, low job satisfaction, and staff turnover. So far, little attention has been paid to the moral concerns specific to elderly care, a field whose importance is constantly growing as the populations in Western countries age. By drawing on seven workshop conversations as data and interaction-oriented focus group research, conversation analysis and discursive psychology as methods, we aim to study the ways in which elderly care practitioners discuss moral distress in their work. We found that the moral distress experienced was related to three topics that arose when client work and teamwork contexts were discussed: the power to influence, equal treatment of people, and collaboration. The interaction in client work and teamwork contexts differed systematically. The discussion on client work was characterised by negotiations on the rights and wrongs of care work, whereas the teamwork discussion engendered emotional outbursts, a potential manifestation of work-related burnout. Hence, attempts to improve the work-related health of elderly care practitioners require time and space for sharing the emotional load, followed by reflection on what could be improved in the work and what institutional solutions could help in morally distressing situations.

Effectiveness of a workplace intervention to reduce workplace bullying and violence at work: study protocol for a two-wave quasi-experimental intervention study.

INTRODUCTION: Bullying and violence at work are relatively common in Finnish public sector workplaces. Previous research has demonstrated their association with increased risk of poor health and well-being, but only few intervention studies exist. The aim of this protocol paper is to describe the development and assessment of the effectiveness of a workplace intervention aimed at reducing these harmful phenomena. METHODS AND ANALYSIS: This protocol describes a two-wave quasi-experimental intervention. Each of the three participating Finnish public sector organisations (cities) will select four work units (a total of 450-500 employees) to participate in an intervention including 2-3 workshops for the work unit, 2-3 consultative meetings with the supervisor of the work unit, a follow-up meeting for the entire work unit (a maximum of 6-month time lag) and online meetings with the supervisor to monitor achievements and discuss about difficult cases, if any. Three age-matched, sex-matched and occupation-matched controls for each participants of the intervention group will be randomly selected, a total 1350-1500 individuals in the control group. For intervention and control groups, premeasurement is based on responses to a survey that was conducted in 2020. Postintervention measurement will be based on survey responses in 2022. Data will be analysed using latent change score modelling or difference-in-difference analysis. ETHICS AND DISSEMINATION: Ethics approvals are from the Ethics committees of the Helsinki and Uusimaa hospital district and the Finnish institute of Occupational Health. Results will be made available to participating organisations and their employees, the funder and other researchers via open access article in a peer-reviewed journal and subsequent reporting of the results via social media channels and press release to the public.