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Municipal elderly care: implications of registered nurses' work situation, education, and competence
Örebro University, Department of Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Registered nurses (RNs) are key figures in municipal elderly care. It is a challenge to create necessary conditions that enable them to provide quality nursing care. These studies aimed to increase insight into RNs work conditions in municipal elderly care, and to compare RNs working solely in dementia care (DC) with RNs working in general elder care (GC). The specific aims were to describe RNs’ perceptions of: (I) their work situation, regarding demands, influences, and social support, as well as RNs characteristics; (II) violence and threats directed at them, other staff, and care recipients, as well as access to prevention measures and routines for handling violence and threats; (III) their education and competence development; (IV) their needs for knowledge, possibilities for competence development, supervision, organisation of RNs’ development, financial support, competence utilisation, and managers’ competence. A descriptive and comparative design was used. The setting consisted of 60 special housing with subunits in a large city in the middle of Sweden. A total of 213 RNs participated, with a response rate of 62%. Of those, 95 (45%) worked in DC and 118 (55%) in GC. A structured questionnaire, designed for these studies was used. Study I showed on average high time pressure in both groups. Greater knowledge and higher emotional and conflicting demands were found in DC. The majority reported greater opportunities to plan and perform daily work tasks than to influence the work situation in a wider context. On average, there was a high level of support at work from management and fellow workers. Study II indicated that RNs had witnessed and experienced a high degree of indirect threats, direct threats of violent acts, and violent acts, with care recipients also subject to threats and violence. The RNs in DC had greater access to education in managing threats and violence, and routines for managing violence and a door with a lock to their working unit. Study III revealed that RNs possessed a broad range of formal competence. On average, the RNs had 18 years of work experience as an RN. The majority lacked a Degree of Bachelor in Nursing. Few had adequate specialist competence. RNs in DC were willing to invest more in competence development whereas RNs in GC were more motivated to invest in competence development by seeking another position and by attaining a greater authority to make important decisions at work. Study IV showed that, on average, the RNs did not lack or hardly lacked knowledge in the examined domains. RNs in GC lacked knowledge of dementia, falls, and fall injures to a greater extent than RNs in DC. RNs in DC perceived greater possibilities for competence development at work. Most RNs, especially in GC, requested a better organisation for competence development. The majority of RNs had no supervision. Although the utilisation of the competence of RNs was high, RNs used their highest competence about half of the working hours. The employers’ financial contribution to RNs’ continuing education was poor. Conclusions drawn from the studies are: (I) RNs’ time pressure needs to be decreased and their influence on decisions increased. (II) Violence occurs equally frequently without any difference between DC and GC. More often, RNs in DC are offered education on how to manage violence and threats, and have routines for management of violence. Therefore, municipal authorities should increase staff education for management of violence and creating safety routines. Violence needs to be taken seriously with a ‘zero tolerance’ attitude. (III) It is important to develop the RNs’ competence and increase the utilisation of their competence. It is also essential to increase the number of RNs who have specialist competence. (IV) Better organisation and greater possibilities for RNs’ competence development is needed. Employers need to make a greater financial contribution to RNs’ competence development. RNs also need supervision. When combined, high demands and low control in the work situation form the most critical combination for the health of RNs. This may lead to sick-absenteeism and staff turnover. Thus, RNs’ time demands should be decreased, violence be minimised, and influence in decision-making increased in both groups. Further research is required on RNs’ competence development, family conditions, leisure, health, their ‘ideal work’, and the concept of general elder care.

Place, publisher, year, edition, pages
Stockholm: Karolinska institutet , 2006. , p. 68
Keywords [en]
"registered nurse", "nursing", "municipal elderly care", "work situation", "demand", "control", "influence", "support", "violence", "education", "competence", "competence development", "questionnaire"
National Category
Social Sciences Interdisciplinary Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-3970ISBN: 91-7140-668-9 (print)OAI: oai:DiVA.org:oru-3970DiVA, id: diva2:138269
Note
Doktorsavhandling framlagd vid Karolinska institutet 2006.Available from: 2007-08-30 Created: 2007-08-30 Last updated: 2018-01-13Bibliographically approved
List of papers
1. Work situation of registered nurses in municipal elderly care in Sweden: a questionnaire survey
Open this publication in new window or tab >>Work situation of registered nurses in municipal elderly care in Sweden: a questionnaire survey
2007 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, no 1, p. 71-82Article in journal (Refereed) Published
Abstract [en]

Background: Organizational changes have occurred in municipal elderly care in Sweden during the past decades. The 'Adel' reform transferred responsibility for the care of older persons from the county councils to the municipalities. Furthermore, the specialisation in dementia care divided elderly care into two groups: dementia and general care. This change has had a significant impact on the work situation of registered nurses (RNs). Aim: The main focus was to describe RNs' work situation and their characteristics in municipal elderly care. Another aim was to compare RNs working solely in dementia care with those working in general care of older persons with diverse diagnoses. Design: A non-experimental, descriptive design with a survey research approach was used. Settings: Sixty special housing units with underlying units including those offering daytime activities in a large city in the middle of Sweden. Participants: The number of participating RNs was a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in dementia care, and 118 (55.4%) in general care. Method: A questionnaire survey. Results: The results indicated high levels of time pressure in both groups. Greater knowledge and greater emotional and conflicting demands were found in dementia care. The majority perceived a greater opportunity to plan and perform daily work tasks than to influence the work situation in a wider context. Support at work was perceived as generally high from management and fellow workers and higher in dementia care. Conclusion: It is important to decrease RNs' time pressure and increase their influence on decisions made at work. (c) 2005 Elsevier Ltd. All rights reserved.

Keywords
registered nurses, municipal elderly care, work situation, demand-control model
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15705 (URN)10.1016/j.ijnurstu.2005.10.014 (DOI)000243668400008 ()
Available from: 2011-05-25 Created: 2011-05-25 Last updated: 2017-12-11Bibliographically approved
2. Violence in municipal care of older people in Sweden as perceived by registered nurses
Open this publication in new window or tab >>Violence in municipal care of older people in Sweden as perceived by registered nurses
2007 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 5, p. 900-910Article in journal (Refereed) Published
Abstract [en]

Aims. The main aim was to describe registered nurses' perceptions of violence and threats, as well as their access to prevention measures and routines for handling violent behaviour in municipal care of older people. Another aim was to compare nurses' perceptions working solely in dementia care with those working in general elder care where older people have diverse diagnoses. Background. Violence is often reported in care of older people. The development of dementia units and the implementation of reform have changed care of older people. Dementia disorders have been shown to be a predisposing factor to violence. Design. A non-experimental, descriptive design with a survey research approach was used. The setting was 60 special types of housing with subunits in a large town. The response rate was 62% (n = 213). Forty-five per cent (n = 95) of the nurses worked in dementia care and 55% (118) in general elder care. Method. A questionnaire. Results. Nurses had experienced a high degree indirect threats (dementia care, 45%; general elder care, 51%), direct threats of violent acts (dementia care, 35%; general elder care, 44%) and violent acts (dementia care, 41%; general elder care, 43%). Nurses had witnessed violence and threats towards staff (dementia care, 49%; general elder care, 38%). Even care receivers (dementia care, 20%; general elder care, 19%) were subjected to violence and threats. No statistical differences were found between groups. The nurses in dementia care had more access to education in managing violence and threats, as well as routines for handling violence and a door with a lock to their working unit. Conclusion. Violence occurred frequently in municipal care of older people without any difference between dementia care and general elder care. Nurses in dementia care were more often offered education on how to manage violence and had routines for when violence occurs. Relevance to clinical practice. Municipal authorities should increase staff education for handling violence and creating safety routines. Violence needs to be taken seriously with a 'zero tolerance' attitude.

Keywords
care receiver, municipal elderly care, questionnaire, registered nurse, staff, violence
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15703 (URN)10.1111/j.1365-2702.2006.01835.x (DOI)000245988900011 ()
Available from: 2011-05-25 Created: 2011-05-25 Last updated: 2017-12-11Bibliographically approved
3. Registered nurses' education and their views on competence development in municipal elderly care in Sweden: a questionnaire survey
Open this publication in new window or tab >>Registered nurses' education and their views on competence development in municipal elderly care in Sweden: a questionnaire survey
2007 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, no 2, p. 245-258Article in journal (Refereed) Published
Abstract [en]

Background: Recent changes of municipal elderly care in Sweden have resulted in that persons 65 years and older, previously nursed in hospital facilities, are now being cared for in the municipality. This change has had a significant impact on the work situation of registered nurses (RNs) and calls for appropriate educational preparation to enable RNs to undertake their new roles effectively. Aim: The main focus was to describe RNs' education and their view of competence development in municipal elderly care. Another aim was to compare RNs working solely in dementia care (DC) with those working in general elder care (GC) of older persons with diverse diagnoses. Design: A non-experimental, descriptive design with a survey research approach was used. Settings: Sixty special housing with subunits including those offering daytime activities in a large city in the middle of Sweden. Participants: The number of participating RNs was a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in DC, and 118 (55.4%) in GC. Method: A questionnaire survey. Results: The findings showed that RNs possessed a broad range of competence. The majority lacked a bachelor's degree in nursing. Few had adequate specialist competence. RNs' in DC wanted to invest more in competence development whereas RNs in GC were more motivated to attain greater authority in the making of important decisions and to seek another position. Conclusion: An important future prospect is to develop the competence of RNs in elderly care. In order to ensure high quality and security in elderly care, it is also essential to increase the number of RNs with specialist competence. (c) 2005 Elsevier Ltd. All rights reserved.

Keywords
competence, education, municipal elderly care, questionnaire, registered nurse
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15704 (URN)10.1016/j.ijnurstu.2005.11.029 (DOI)000244402300011 ()
Available from: 2011-05-25 Created: 2011-05-25 Last updated: 2017-12-11Bibliographically approved
4. Competence development of registered nurses in municipal elderly care in Sweden: a questionnaire survey
Open this publication in new window or tab >>Competence development of registered nurses in municipal elderly care in Sweden: a questionnaire survey
2008 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 45, no 3, p. 428-441Article in journal (Refereed) Published
Abstract [en]

Background: Skilled and specialist registered nurses (RNs) are central to evolving elderly care. The past decades' organisational and structural changes have altered RNs' roles and work situations in municipal elderly care in Sweden. This calls for appropriate educational preparation. However, a substantial proportion of RNs in municipal elderly care lack adequate specialist competence. Aim: The focus of this study was to describe RNs' perceptions of needs and possibilities for competence development in municipal elderly care and compare the perceptions of RNs' who work solely in dementia care (DC) with those who work in general elder care (GC) where older persons have diverse diagnoses. Design: A non-experimental, descriptive and comparative design was used. Settings: Sixty special housing with subunits in a large city in the middle of Sweden. Participants: Participating RNs were a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in DC and 118 (55.4%) in GC. Method: A structured questionnaire that was specifically designed for this study and focused on needs and possibilities for competence development in nursing. Results: The RNs were on average not lacking or were hardly lacking knowledge in examined domains. However, RNs in GC lacked knowledge of dementia, falls, and fall injures to a greater extent than RNs in DC. RNs in DC perceived greater possibilities for competence development at work. Most RNs requested a better organisation for competence development, especially in GC. The majority of RNs had no supervision. The use of RNs' competence was high, although they used their highest competence about half of the working hours. The employers' financial contribution to RNs' continuing education was poor. Conclusion: A better organisation and greater possibilities for RNs' competence development is needed. The employers need to make a greater contribution financially to RNs' continuing education. It is essential to provide RNs with supervision. (C) 2006 Elsevier Ltd. All rights reserved.

Keywords
competence development, municipal elderly care, questionnaire, registered nurse
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15702 (URN)10.1016/j.ijnurstu.2006.09.009 (DOI)000254142400012 ()
Available from: 2011-05-25 Created: 2011-05-25 Last updated: 2017-12-11Bibliographically approved

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  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
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  • Other locale
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Output format
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  • asciidoc
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