Consequences of Working in Eldercare during Organizational Changes and Cut Backs While Education and Clinical Supervision Was Provided:A Mixed Methods Study  

作　　者：Birgitta Flackman Kirsti Skovdahl Ingegerd Fagerberg Mona Kihlgren Annica Kihlgren 

机构地区：[1]Department of Health Care Sciences,Ersta Skondal University College,Stockholm,Sweden [2]Faculty for Health Sciences,Buskerud and Vestfold University College,Drammen,Norway [3]Department of Neurobiology,Care Sciences and Society,Karolinska Institute,Stockholm,Sweden [4]Centre for Caring Sciences,Orebro University Hospital,Orebro,Sweden [5]School of Health and Medical Sciences,Orebro University,Orebro,Sweden

出　　处：《Open Journal of Nursing》2015年第9期813-827,共15页护理学期刊（英文）

基　　金：the Swedish Association of Local Authorities in Gavleborg,the Centre for Caring Sciences,Orebro University Hospital and to the University of Gavle for their financial support during the study.

摘　　要：Background: Reorganization and downsizing can disrupt a competent staff and conflicts can arise between what the employee is being asked to do and their knowledge and competences. Reduced job satisfaction among nursing home staff with increased workload and strain can occur. Aim and Objectives: The aim was to investigate the organizational climate and prevalence of burnout symptoms among caregivers over time in three Swedish nursing homes (NH I-III) undergoing organizational changes, while education and clinical supervision were provided. Design: The study design combines qualitative and quantitative methods in a longitudinal two-year follow-up project in NH I-III. Methods: Support through education and clinical supervision was provided for caregivers only at NH I and NH II. At NH I-III caregiver self-assessments and interviews were completed and analysed three different times. Results: NH I revealed improvement and increased innovation over time, while NH II showed a decline with no ability to implement new knowledge. NH III retained a more status quo. Conclusions: Organizational changes and cutbacks, occurring at different times, appeared to cause major stress and frustration among the three personnel groups. They felt guilty about not meeting their perceived obligations, seemed to have lost pride in their work but kept struggling. The changes seemed to over-shadow attempts to improve working conditions through education and clinical supervision initially. Implications for practice: It will be important to learn from reorganizations and the consequences they will have for the staff and quality of care. Important topics for future research are to study financial cutbacks and changes in organizational processes in care of older people to be able to develop a more person centered care for older people.Background: Reorganization and downsizing can disrupt a competent staff and conflicts can arise between what the employee is being asked to do and their knowledge and competences. Reduced job satisfaction among nursing home staff with increased workload and strain can occur. Aim and Objectives: The aim was to investigate the organizational climate and prevalence of burnout symptoms among caregivers over time in three Swedish nursing homes (NH I-III) undergoing organizational changes, while education and clinical supervision were provided. Design: The study design combines qualitative and quantitative methods in a longitudinal two-year follow-up project in NH I-III. Methods: Support through education and clinical supervision was provided for caregivers only at NH I and NH II. At NH I-III caregiver self-assessments and interviews were completed and analysed three different times. Results: NH I revealed improvement and increased innovation over time, while NH II showed a decline with no ability to implement new knowledge. NH III retained a more status quo. Conclusions: Organizational changes and cutbacks, occurring at different times, appeared to cause major stress and frustration among the three personnel groups. They felt guilty about not meeting their perceived obligations, seemed to have lost pride in their work but kept struggling. The changes seemed to over-shadow attempts to improve working conditions through education and clinical supervision initially. Implications for practice: It will be important to learn from reorganizations and the consequences they will have for the staff and quality of care. Important topics for future research are to study financial cutbacks and changes in organizational processes in care of older people to be able to develop a more person centered care for older people.

关 键 词：Nursing Home Organizational Climate and Burnout Education and Clinical Supervision Cutbacks and Organizational Changes 

分 类 号：R73[医药卫生—肿瘤]