Rozprawy doktorskie na temat „Integrative Workplace Health Management”

Over the past three decades, globalisation and rapid technological advances have fundamentally changed socio-economic structure and have widespread impacts on the nature of work and workplace health (U. Beck, 2000; Bertucci & Alberti, 2004; Bhalla, 1996; Chu & Dwyer, 2002). They have led to fierce global competition, altered the nature of work and exposed employees to new health risks (Chu & Dwyer, 2002; Stitzel & Jarvisalo, 1997). Fierce market competition demands enterprises and industries to build new competencies, restructure and improve productivity and efficiency. Associated with these changes are increased work pressures, weakening commitment to occupational health and safety, and many negative impacts on workers’ health (G. Breucker, 2006; Missler & Theuringer, 2003; WHO, 2003). Evidence shows that the world is facing growing burden of work related fatalities, injuries and diseases, particularly a dramatic increase of work stress. As part of the global community, Taiwan has also encountered similar workplace challenges in the rapidly changing environment. It also has to confront with increasing costs from the burden of work-related injuries and diseases and to find appropriate ways to deal with the serious problems (Council of Labour Affairs Taiwan, 2003, 3005; IOSH, 2002). As the success of organisations relies on having well-qualified, motivated and healthy employees, it is essential to seek effective means to protect and promote the health of the working population (ENWHP, 2005). The integrative workplace health promotion (IWHM) model emerging in the 1990s, is regarded as a comprehensive means to address multiple determinants of health and promote employee health (G. Breucker, 2006; Chu, 2003b; WHO-WPRO, 1999). There have been a great number of international successful examples demonstrating the benefits from implementing the IWHM programs (ENWHP, 2002; Chu, Breucker, Harris, & et al., 2000). In response to these workplace challenges and new occupational health risks, Taiwan has followed the international trend to initiate a series of workplace health promotion (WHP) programs since 2001 (Bureau of Health Promotion Taiwan, 2006). However, a preliminary study revealed that many WHP projects in Taiwan have met with difficulties in encouraging employee participation and sustainable development of the programs. These results were not surprising as the majority of the WHP programs in Taiwan tended to narrowly focused on physical activities, weight control and smoking cessation, while ignoring employee needs and problems relevant to specific workplace concerns (Bureau of Health Promotion, 2003; Hsu, Chang, Peng, & Chen, 2002; Hsu, Chen, & Wu, 2004). In this regard, the comprehensive IWHM which aims to meet employee health needs and improve organisational environment may present an effective means for Taiwan to address complex workplace health issues and to create healthy and sustainable workplaces. This research aims to investigate the applicability of the IWHM model in Taiwan to deal with workplace health problems. Apart from reviewing literature and relevant case studies from international communities and in Taiwan, this study conducted a small scale pilot study and a comprehensive needs assessment at selected workplaces in Taiwan as an experiment to test the applicability of the IWHM model. In practice, this research project targeted the civil servants working at the Liming governmental community in Taichung, Taiwan as the research subject. It involves a combination of qualitative and quantitative methods for data collection and analysis. A variety of data collection techniques including in-depth interviews, focus groups, participant observations, secondary data analysis and questionnaire surveys are used to investigate the workplace health and safety problems and the staff’s health needs. A triangulation technique is used to compare and contrast the different sources of information. The findings indicated that the IWHM model is applicable in the Liming community in terms of feasible methodological approaches using a needs-based program development and implementation process, and positive program outcomes such as stair improvement to prevent falls and the establishment of long-term health management, meaningful participation, practical program activities and holistic evaluation. For potential program sustainability, this project has involved employee representatives in program implementation and taking in charge of the ongoing program activities, and has managed to establish interdepartmental partnership to address common workplace health issues. Even though this research project has not made great progress, it has been moving toward meeting the project objectives and the organisations’ needs. From the Liming experience, this research provided recommendations for future development of WHP in Taiwan including: 1) develop national policies to define clear responsibilities in WHP development at different levels; 2) establish appropriate capacity building and training programs; 3) develop practical guidelines and tools tailored to suit Taiwan’s local conditions and needs; 4) set up effective evaluation and quality management system; 5) provide a professional or technical support team to assist workplaces or industries with the development and implementation of WHP programs.

Over the past three decades, globalisation and rapid technological advances have fundamentally changed socio-economic structure and have widespread impacts on the nature of work and workplace health (U. Beck, 2000; Bertucci & Alberti, 2004; Bhalla, 1996; Chu & Dwyer, 2002). They have led to fierce global competition, altered the nature of work and exposed employees to new health risks (Chu & Dwyer, 2002; Stitzel & Jarvisalo, 1997). Fierce market competition demands enterprises and industries to build new competencies, restructure and improve productivity and efficiency. Associated with these changes are increased work pressures, weakening commitment to occupational health and safety, and many negative impacts on workers’ health (G. Breucker, 2006; Missler & Theuringer, 2003; WHO, 2003). Evidence shows that the world is facing growing burden of work related fatalities, injuries and diseases, particularly a dramatic increase of work stress. As part of the global community, Taiwan has also encountered similar workplace challenges in the rapidly changing environment. It also has to confront with increasing costs from the burden of work-related injuries and diseases and to find appropriate ways to deal with the serious problems (Council of Labour Affairs Taiwan, 2003, 3005; IOSH, 2002). As the success of organisations relies on having well-qualified, motivated and healthy employees, it is essential to seek effective means to protect and promote the health of the working population (ENWHP, 2005). The integrative workplace health promotion (IWHM) model emerging in the 1990s, is regarded as a comprehensive means to address multiple determinants of health and promote employee health (G. Breucker, 2006; Chu, 2003b; WHO-WPRO, 1999). There have been a great number of international successful examples demonstrating the benefits from implementing the IWHM programs (ENWHP, 2002; Chu, Breucker, Harris, & et al., 2000). In response to these workplace challenges and new occupational health risks, Taiwan has followed the international trend to initiate a series of workplace health promotion (WHP) programs since 2001 (Bureau of Health Promotion Taiwan, 2006). However, a preliminary study revealed that many WHP projects in Taiwan have met with difficulties in encouraging employee participation and sustainable development of the programs. These results were not surprising as the majority of the WHP programs in Taiwan tended to narrowly focused on physical activities, weight control and smoking cessation, while ignoring employee needs and problems relevant to specific workplace concerns (Bureau of Health Promotion, 2003; Hsu, Chang, Peng, & Chen, 2002; Hsu, Chen, & Wu, 2004). In this regard, the comprehensive IWHM which aims to meet employee health needs and improve organisational environment may present an effective means for Taiwan to address complex workplace health issues and to create healthy and sustainable workplaces. This research aims to investigate the applicability of the IWHM model in Taiwan to deal with workplace health problems. Apart from reviewing literature and relevant case studies from international communities and in Taiwan, this study conducted a small scale pilot study and a comprehensive needs assessment at selected workplaces in Taiwan as an experiment to test the applicability of the IWHM model. In practice, this research project targeted the civil servants working at the Liming governmental community in Taichung, Taiwan as the research subject. It involves a combination of qualitative and quantitative methods for data collection and analysis. A variety of data collection techniques including in-depth interviews, focus groups, participant observations, secondary data analysis and questionnaire surveys are used to investigate the workplace health and safety problems and the staff’s health needs. A triangulation technique is used to compare and contrast the different sources of information. The findings indicated that the IWHM model is applicable in the Liming community in terms of feasible methodological approaches using a needs-based program development and implementation process, and positive program outcomes such as stair improvement to prevent falls and the establishment of long-term health management, meaningful participation, practical program activities and holistic evaluation. For potential program sustainability, this project has involved employee representatives in program implementation and taking in charge of the ongoing program activities, and has managed to establish interdepartmental partnership to address common workplace health issues. Even though this research project has not made great progress, it has been moving toward meeting the project objectives and the organisations’ needs. From the Liming experience, this research provided recommendations for future development of WHP in Taiwan including: 1) develop national policies to define clear responsibilities in WHP development at different levels; 2) establish appropriate capacity building and training programs; 3) develop practical guidelines and tools tailored to suit Taiwan’s local conditions and needs; 4) set up effective evaluation and quality management system; 5) provide a professional or technical support team to assist workplaces or industries with the development and implementation of WHP programs.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Griffith School of Environment
Faculty of Environment and Planning
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A central assumption of extant mHealth literature is that the technology empowers health care staff and leads to increased efficiency in service delivery. This assumption foregrounds the transformative potential of mHealth and the active appropriation of the technology, but obscures how it integrates with existing workplace arrangements. To interrogate the limitations of this dominant assumption, this research examines how mHealth is coordinated in the workplace in practice, and the perceptions and experiences of health care staff of the place mHealth takes in their daily concerns. In this way the research reveals how existing workplace arrangements influence the way that mHealth operates in practice, and builds on extant research to clarify how this can shift responsibility for the success of the implementation onto those staff with the least recognition and security. An interpretive case study explores the coordination of mHealth in the workplace, and analyses unexpected outcomes to identify their implications for theory and practice. In order to highlight this phenomenon the research focussed on the experiences of the clinic staff who were responsible for mHealth implementation, but were not the end users and who did not receive direct benefits themselves. The analysis drew on coordination studies to identify social and artefact-based coordination mechanisms, as well as the significance of relationships in mHealth in the workplace, yielding robust evidence that social coordination mechanisms rather than the fitness for purpose of the specific technology shaped the coordination process. Issues arising from the specific setting also influenced coordination in important ways that were not predicted in the official training material. The research makes three theoretical contributions that advance understanding of mHealth in the workplace through abduction. First, it identifies two novel coordination mechanisms: role flexibility and covert routines. Second, through the novel concept of multiple accountability, it challenges one of the key integrative principles proposed in the coordination studies perspective, problematising it and proposing that relationships between health intermediaries and local communities are far more influential for the coordination of mHealth than extant theory has so far proposed. Third, it carries important implications for future mHealth (and, more broadly, technology coordination) scholarship, providing evidence that existing coordination mechanisms and relationships may be as influential as the transformative potential of the technology itself. The research also contributes to practice by enhancing understanding of how health intermediaries may be empowered to effectively employ mHealth in the workplace. In a context of policy and funding uncertainty, this research contributes to an emerging literature identifying the practical mHealth issues primary health care staff face in a resource-poor environment, interrogating approaches that fail to recognise these realities.

Every day, India sees the addition of 5,000 new cases of diabetes to its current diabetic population of 65 million people. This number is projected to cross the 100 million mark in 15 years. The emerging pandemic scale of diabetes growth is straining India's already-overburdened public healthcare resources. India is home to several well-established native and adapted foreign traditions of medicine that are widely practiced. These traditions include Ayurveda, yoga and naturopathy, unani, siddha, and homeopathy. The modern and traditional medicine approaches are extensively used as independent systems. The purpose of this qualitative research case study was to evaluate the use of an integrative approach to address the multiple challenges posed by diabetes in India. The research design for the case study was based on the theoretical framework of participatory action research. The research questions evaluated how the modern and traditional medicine systems can be jointly used to contain the spread, scale, and immensity of diabetes in India and examined the barriers and challenges in combining various systems of medicine. Data were collected from interviews with 30 modern and traditional medical practitioners and 6 policy makers identified through a stratified purposeful sampling process. The transcribed data were coded thematically and objectively analyzed. The trustworthiness of interpretations was bolstered with triangulation through records from notes and observations. In evaluating the feasibility of a synergistic and integrative approach, the study filled a gap in scholarly literature. The study contributes to social change by adding to the existing body of knowledge available to physicians and patients in preventing and containing the diabetes pandemic.

Healthcare today is constantly transforming as hospital systems are challenged to maximize productivity and value. Factors such as occupational stress, difficult working conditions, unresolved conflict, lack of leadership, and increased complexity of healthcare foster disruptive and uncivil behavior and directly impact work performance, patient safety, and the physical well-being of those providing or supporting the care given to patients. The objectives of this study were to: 1. assess the prevalence of incivility within a large metropolitan healthcare organization, 2. determine differences in the frequency of incivility within select occupational groups, and 3. examine the relation between incivility and productivity, organizational commitment, job satisfaction, and workplace stress. The study was a cross-sectional, correlation design, using survey methodology. Data were collected from employees working in one organization consisting of an acute care facility, outpatient centers, and ambulatory locations. The study population included direct and non-direct patient care job categories and physicians.

Bullying has long been associated with school children. In recent years, however, more attention has been paid to the bullying that has reached beyond the playground and into the workforce. One population facing this problem is staff nurses. To date, no one has found an effective way to address workplace bullying in the healthcare field, nor have effective methods been found for retaining trained nurses affected by this problem. The focus of this dissertation was on understanding nurses’ lived experiences and how nurses decided to remain in their current working position despite these problems. Taking a phenomenological approach and using the conceptual framework of resilience, the study included telephone interviews of 2 pilot study participants and 12 main study participants. Recorded and transcribed participant responses to interview questions were coded thematically and analyzed. Three main themes emerged: stories of working with workplace bullying, challenges of the lived experiences of being bullied, and special techniques of nurses being bullied. Three subthemes also emerged: despair, love of being a nurse, and resilience. This study gave a voice to nurses affected by this problem, revealing special challenges they encounter and coping strategies they employ. Hospital administrators can use the findings of this study to create social change within nurses’ working environment by implementing policies that will keep their nurses safe and happily employed. Future research should focus on workplace bullying in the nursing field and how it affects patient safety.

Eighty one percent of employers offer programs that focus on wellness (Hewitt, 2005 & Collins, 2004), but most do not have the resources to hire a health professional, and less than 40% of those that implement wellness programs have training. Qualitative and quantitative data were used to identify ways health professionals can support practitioners who are implementing wellness programs.Results showed that survey respondents are involved with wellness of their personal interest (94%, N=52). Since few have had training, workshops in a community setting are a good way for implementers to discuss challenges, successes, and ideas.Recommendations from this study include facilitating more canned programs that allow for tailoring, creating networking opportunities for wellness program implementers, allowing for more time during workshops for discussion of program materials, focusing on ways to overcome barriers.
Fisher Institute for Wellness and Gerontology

In the advent of the unprecedented occurrence of PTSD among both the young and old population, a group of volunteers and health care professionals have created a treatment and healing program using scientific and holistic approaches for a complete “mind, body, & soul” detoxification allowing the individuals to reset and resolve all mental injuries caused by traumas they received. To enhance the effectiveness of this program, the Flower of Life Retreat & Healing Center, Inc. (FoL, Inc.) has conceptualized a beautiful lakeside facility with a total of 45 acres of green land with serene natural beauty in the suburbs of San Diego, California. The facility’s primary focus is to provide treatment for PTSD in conjunction with other related programs and treatments for anxiety, depression, and addiction.

The opioid epidemic in the United States continues to be a national health crisis affecting all populations. From 1999 to 2016, more than half a million people died from drug overdose. Nonpharmacological therapies are underused in nursing practice due to the gap in nurses' baseline knowledge and confidence related to nonpharmacological techniques for pain management. The purpose of this scholarly project was to develop and implement an expert-reviewed, evidence-based education program focused on nonpharmacological techniques for pain management. Participants included 18 registered nurses (RNs) from an orthopedic unit in a large academic medical center. A 45-minute educational session was conducted for RNs. A pre/postquestionnaire, including a 5-point Likert scale on nurses' self-perceived knowledge and confidence in using selected nonpharmacological techniques, was the method of data collection. Descriptive statistics were used to analyze the data. The results indicated an increase in nurses' self-perceived knowledge in all nonpharmacological techniques. The most significant increase in knowledge posteducation intervention was guided imagery with an increase of 72% in terms of the response Good. The data analysis indicates that the nurses self-perceived confidence posteducation intervention increased in terms of the response Good by 50 % and response Excellent by 33% demonstrating the efficacy of an evidence- based education program on nonpharmacological techniques. The implications of this project for social change include the empowerment of nurses to provide holistic patient-centered care, opioid sparing in keeping in alignment with patient safety, and the development of an evidence-based program that can be replicated in other settings.

Acting ethically is a core facet of the counseling profession's identity, safeguarding clients from undue harm (ACA, 2005). Through an increased understanding of both detrimental and positive factors that can influence counselors' perceptions of ethical behaviors, the counseling profession can intervene accordingly; this knowledge may assist in managing the problem related to unethical infractions. However, ethical behavior is a multifaceted and complex phenomenon, leaving many factors to be explored and examined. Workplace aggression, exposure to normative unethical behaviors, and an integrated modal of morality constitute some of these factors that warrant further investigation. A dearth of research currently exists within the counseling profession that examines the effects of workplace aggression and exposure to normative unethical behavior on counselors' perceptions of ethicality. Additionally, mediating variables in the context of acting ethically have scantly been researched within the counseling profession, including moral development and the moral foundations of care, fairness, and justice (integrated modal of morality). The present study investigated these various variables and the subsequent affects/relationships that ensued on counselors' perceptions of ethicality. Two phases of research were conducted: a pilot study (n = 166) that assisted in the development a Perceived Ethical Perceptions Instrument and a main study (n = 76) that assessed perceived ethicality contingent on the variables of workplace aggression, normative unethical behaviors, and the integrated modal of morality. Results from this study substantiated the complexity inherent within perceptions of ethicality, indicating that certain contextual factors may affect facets of perceived ethicality differently. of particular interest, the current study indicated that workplace aggression and the occurrence of unethical infractions by work supervisors/bosses and peers necessitated further investigation.;Keywords: ethical perceptions, workplace aggression, integrative modal of morality.

This exploratory research increases knowledge and understanding of blame in the workplace. Attribution theory, moral philosophy, and social cognition provided a theoretical framework to understand individual blame determination as a precursor to understand systemic blame. Systemic blame is informed by complex systems theory and research on "no blame" cultures in a healthcare setting.

Interpretive description, supported by applied thematic analysis, provided the methodological framework for this qualitative study. The 17 senior leaders interviewed for this research study were selected through purposive sampling, and individually had an average 28 years of experience in healthcare. The semi-structured interviews were designed to gather experiences and stories that informed the participants' perspectives on blame in the workplace.

Constant comparative thematic analysis of the data resulted in four main findings. First, blame is prevalent in the workplace. Second, blame begets blame through a vicious cycle of blame. In this cycle there is often unwarranted blame. Blame feels bad, which results in fear of blame and avoidance of blame. One way to avoid blame is to blame someone else. This positive reinforcing feedback loop of blame creates a culture of blame. Third, a culture of blame includes characteristics of risk aversion and mistrust. Risk aversion decreases innovation, and mistrust decreases transparent communication. Fourth, blame has an inverse relationship to accountability, where less blame may result in more accountability. These findings both confirm and contradict the current literature. The resulting conclusion is blame is not a game.

A Survey of Physical Therapists’ Perceptions of Workplace Ethics in the State of Georgia. Roberto Cantu, 2014: Applied Dissertation, Nova Southeastern University, Abraham S. Fischler School of Education. ERIC Descriptors: Physical Therapy, Ethics, Conflict of Interest, Ethical Instruction, Job Satisfaction.

This study examined how physical therapists in Georgia perceive ethical climates in their workplaces, based on the use of the Ethics Environment Questionnaire (EEQ), and how these perceptions may be different based on the type of workplace, financial status of their workplaces, their respective positions within their organizations, their age, gender, and years in the profession.

Questionnaires were sent to a random sample of 1200 physical therapists in Georgia; 340 surveys were completed and returned. The results suggested that, overall, physical therapists in Georgia are satisfied with the ethical environments of their workplaces. The average score was 3.8, higher than the 3.5 cutoff score that indicates an ethical environment. The only sub-group that scored below 3.5 on the EEQ were those who worked in skilled nursing/assisted living facilities (M = 3.35, SD = .67). There was a statistically significant difference in scores between therapists working in for-profit settings (M = 3.75, SD = .55) and therapists working in not-for-profit settings (M = 3.88, SD = .45; t (335) = -2.21, p = .027). Clinicians had the lowest perceptions of ethical climate (3.73), executives/owners the highest (4.29), with middle managers scoring in between the two groups. There were strong negative correlations between the perception of an ethical environment with burnout and intent to leave the place of employment (r_s = -.66, p < .01; r_s = -.524, p < .01).

Increased governmental/insurance regulation, increased paperwork, decreased reimbursement, and productivity issues were areas of most concern to therapists. Greater communication and dialogue between clinicians and managers was the dominant theme in the recommended solutions to these concerns.

Incivility is a low-level form of violence that has been found to threaten safety and has gained increasing attention from healthcare leaders. Incivility at work causes distractions and threatens the culture of safety. Locations providing mental health services are among such high-risk areas. The purpose of this study was to evaluate the effectiveness of a nurse leader’s educational approach to improve civility in the mental health (MH) nursing workplace using assertiveness training with role-play.

The civility score in this study was measured by staffs’ perceptions of eight items: respect; conflict resolution; cooperation; anti-discrimination; value differences; diversity acceptance; personal interest; and reliability of team members. In this study, the principal investigator (PI), a MH nurse leader, prepared and implemented a six-month plan of evidence-based actions intended to improve civility and to strengthen the sense of community.

Role-play exercises were included in assertiveness training sessions. Personalized brochures that summarized information and future direction for improving civility were prepared and distributed.

Civility awareness and assertiveness were reinforced by sharing literature, facilitating discussions, and practicing occasional role-plays to problem-solve past and current incivilities as they surfaced. Follow-up measurements showed a rapid and sharp increase in civility, with improved scores for each of the eight items. These findings support continued use of assertiveness training with role-play as an effective approach for improving civility in a culturally diverse MH nursing staff. Limitations of this study are discussed.

Inadequate leadership is the reason workplace accidents in the mining industry remain high, making the industry one of the most hazardous operational activities in the world. Unsafe leadership practices may result in death or injury to workers. A group of 30 mining company leaders from 3 gold mines in Zimbabwe revealed an exception to these hazardous practices, however, notable through their outstanding safety improvement records. To better understand what these practitioners were doing, this multicase study research design explored their strategies to improve the workplace safety environment in the mines. Data were collected using audio-recorded semistructured interviews and document analyses. Shewhart’s plan-do-check-act conceptual framework anchored the study. Data analysis followed the thematic data analytic approach involving classification, coding, and interpretation to identify common themes. The following themes emerged: planning and organizing, leading, and risk management. The findings indicate that the business leaders created a safe work environment by planning the work to be performed; how the task would be executed; and when, where, and who performed the task. The results of study also indicate that leaders designed the work environment, trained, empowered, and equipped employees with the relevant skills, and provided appropriate technology and personal protective equipment to improve workplace safety. Finally, the research findings indicate that leaders embedded risk management principles and practices in every process or activity, and continuously learned from each event to create a safe work environment. The findings promote social change by encouraging safe behavior and risk-based thinking and practices in the workforce and the community.

Work-related accidents emerge from potential hazards that can cause different negative outcomes in different situations. Human errors are specific actions that can either directly (active errors) or indirectly (latent errors) cause an accident in the workplace. Nowadays in order to establish an applicable system in the way of maintenance and preferment of a work environment without any accidents that are trying to develop the HSE system. In fact, this management system has been using as a significant tool to control and improve the performance of health and safety and the environment in all development programs of industries and organizations. In this term, one of the important perspectives of HSE management is Emotional Intelligence which deals with the management’s ability and safety performance in the workplace. The purpose of this study is to investigate the relationship between Emotional Intelligence and Occupational Health, Safety and Environment (HSE) management in the workplace, to reduce industrial incidents of human factors. Therefore, there is a requirement for a better understanding of how Emotional Intelligence factors influence health and safety performance in the workplace. A qualitative study has been done to achieve this purpose. In this case, data has been collected through eight semi-structured interviews with HSE managers and officers that participated from different industries around the world.  The main focus of this collection data was extracting the perspectives of the individual’s views. Afterward, to create a theory, the data has been analyzed according to different steps for a grounded analysis regarding discovering how the Emotional Intelligence factors of employees impact their health and safety performance in the workplace.   The results of this study have shown that there are mainly two areas to study which are key roles of Emotional Intelligence in safety performance and key roles for effective Healthy, Safety, and Environment management. It has shown that the key roles of Emotional Intelligence in safety performance is being able to manage your own and being able to deal with other’s emotions. Besides, key roles for effective Healthy, Safety, and Environment management only three factors have been important to improve the safety act which is being able to make the correct decision in the emergency situation’ and ability to prevent incidents at the workplace as well as the level of perception of risk. These results demonstrated that strong factors of Emotional Intelligence are vital to improve the health and safety performance at the workplace and the improvement of these abilities should be approached for the workplace.

Integrative Medicine (IM) is a care approach that focuses on the overall well-being and healing process of patients rather than solely on their disease. IM educates and empowers people to be active players in their own care, emphasizes the therapeutic relationship, and makes use of all appropriate evidence-based approaches. The health-oriented foundations of IM are in line with the recently posed concept that describes health as ”the ability to adapt and to self-manage”. Due to the shared underpinnings of both IM and the new concept of health, incorporation of this new concept of health may serve as a facilitator for the development and implementation of IM. From a practical viewpoint, working from an integrative care approach requires specific competences from healthcare providers, such as socio-communicative and self-reflective skills, and reflexivity towards a holistic perspective on health. Previous studies have shown that a Mind-Body Medicine (MBM) course can potentially foster these competences among future healthcare providers. This thesis intended to gain increased insight into the prerequisites and tools for implementation of IM. Therefore, in the first part it aimed to explore the attitudes and practice of IM among Dutch nurses and the support for the new dynamic concept of health as ”the ability to adapt and to self-manage” among main stakeholders within the Dutch healthcare community. Furthermore, in the second part it aimed to evaluate the possibilities of an MBM course among medical and nursing students as a tool to foster an integrative care approach. Methods Both quantitative and qualitative research designs were used. Attitudes and practice of IM were assessed in a semi-structured survey study among 355 Dutch nurses (study I). Support for the new concept of health was explored in a mixed method study, where in the first step data from interviews and focus-groups among 140 stakeholders were investigated by use of manifest content analysis, and in the second step a cross-sectional survey was performed among 1938 stakeholders to verify the findings of the first step (study II). The MBM course was evaluated by a controlled, quasi-experimental intervention study (74 participants / 61 controls among medical students and 47 participants / 64 controls among nursing students) in which validated questionnaires were used (study III). Furthermore, in-depth interviews with 11 medical and 15 nursing students were employed and analysed by a Phenomenological Hermeneutical method to obtain an in-depth understanding of the meaning of the MBM course for the participants (study IV). Findings Study I showed an overall positive attitude towards IM among nurses. Patient-centeredness and a focus on individuals’ own resources and responsibility to promote health met the most support among both nurses and other stakeholders. These elements were considered to be the main positive aspects of the new dynamic concept of health among stakeholders as well (study II). Use of evidence-based and safe complementary therapies and a healing environment received some support from the nurses, but lack of knowledge and lack of evidence seems to hinder further incorporation in the current healthcare practice (study I). Additionally, study II revealed that health was perceived to comprise six dimensions: bodily functions, mental functions & perception, spiritual / existential dimension, quality of life, social and societal participation and daily functioning. In line with patients, nurses had a more broad conception of health in comparison to other healthcare professionals. Study III showed long-term beneficial effects of the MBM course on two dimensions of empathy (personal distress and empathic concern) among medical students, and on perceived stress and empathy (personal distress) among nursing students. Study IV brought forth that the MBM course can be understood as a pathway to inner awareness and a support to connecting with others as well as the outside world. The following themes were identified: “ability to be more present”, “an increased perception and awareness of self”, and “connecting on a deeper level with others”. Conclusion It can be concluded from the results in the first explorative part of this thesis that the observed positive attitudes and perceptions among healthcare professionals toward IM and the newly proposed health concept can serve as important facilitators for further implementation of IM within the Dutch healthcare system. Furthermore, the increased ability to deal with stress, improved empathic abilities and more openness toward different perspectives on health and new treatment options among medical and nursing students following a MBM course, as reported in the second part of this thesis, suggest that this course might be a suitable tool to foster an integrative care approach among future healthcare professionals.
IM (Integrativ Vård mer adekvat term på svenska) är ett vårdkoncept/vårdansats som mer fokuserar på patienters välmående och läkeprocesser än enbart deras sjukdom. IM överlämnar makten och utbildar individen till att själv bli aktiva i sin vård, den framhäver vikten av en god vårdande relation och använder alla tillämpliga evidensbaserade metoder. Den hälsofrämjande grunden i IM är i linje med ett nyligen utvecklat hälsobegrepp, som beskriver hälsa som ”en persons förmåga till att anpassa sig och hantera utmaningar”. Utifrån den liknande grunden och förutsättningarna hos IM och det nya hälsobegreppet så kan en integration av dem vara en understödjande faktor för utveckling och implementering av IM. Utifrån en praktisk synvinkel så innebär en integrativ vårdansats att den som vårdar måste inneha specifika kompetenser och förmågor relaterade till bland annat socio-kommunikativ och självreflektiv förmåga, såväl som en reflektiv öppenhet till ett holistiskt perspektiv på hälsa. Tidigare forskning har visat att en Mind-Body Medicine (MBM) kurs potentiellt kan understödja utveckling av dessa kompetenser bland framtida vårdare. Denna avhandling avsåg i första hand att uppnå ökad insikt i förutsättningar och verktyg för implementering av Integrativ Vård. Mer specifikt syftade den till att beskriva attityder till, och utövande av IM bland Nederländska sjuksköterskor, samt undersöka stödet för det nya dynamiska hälsobegreppet (”en persons förmåga till att anpassa sig och hantera utmaningar”) bland intressenter inom Nederländsk Hälso- och Sjukvård. Vidare i andra hand, avsåg avhandlingen också att utvärdera förutsättningarna för att använda en MBM kurs som ett verktyg till att understödja och fostra ett mer integrativt förhållningssätt bland läkar- och sjuksköterskestudenter. Metod Både kvantitativ såväl som kvalitativ forskningsdesign tillämpades. Attityder till, och utövande av IM undersöktes i en semistrukturerad enkätstudie bland 355 Nederländska sjuksköterskor (studie I). Stödet för det nya hälsobegreppet undersöktes i en studie som genomfördes med mixad design, där i det första steget data från individuella- och fokusgruppintervjuer bland 140 intressenter genomgick en manifest innehållsanalys, och i det andra steget genomfördes en tvärsnittsstudie bland 1938 intressenter för att validera fynden från det första steget (Studie II). MBM kursen utvärderades i en kontrollerad, kvasi-experimentell interventionsstudie (71 deltagare/61 kontroller bland läkarstudenter, och 47 deltagare/64 kontroller bland sjuksköterskestudenter) med validerade frågeformulär (Studie III). Vidare även i en Fenomenologisk-Hermeneutisk ansats via individuella intervjuer med 11 läkar- och 15 sjuksköterskestudenter för att uppnå en djupare förståelse över MBM kursens betydelse för deltagarna (Studie IV). Fynd I studie I framkom att sjuksköterskorna övergripande hade en positiv attityd till IM. Patientcentrering och fokus på individens resurser, samt deras egna ansvar för att arbeta hälsofrämjande var områden som hade mest stöd bland både sjuksköterskor och andra intressenter. Dessa element ansågs också av intressenterna vara den mest positiva aspekten av det nya dynamiska hälsobegreppet (Studie II). Användandet av evidensbaserade komplementärmedicinska metoder och hälsofrämjande miljöer stöddes till viss del av sjuksköterskorna men brist på kunskap och brist på evidens förefaller vara hinder för integration i nuvarande vårdpraxis (Study I). I studie II framkom att begreppet hälsa uppfattades som att bestå i sex olika dimensioner; ”kroppslig funktion”, ”mental funktion och perception”, ”spirituell/existentiell dimension”, ”livskvalitet”, ”social-samhällelig inklusion” samt ”daglig funktion”. I samklang med patienter, så hade sjuksköterskor en bredare syn på hälsa än andra hälsoprofessioner. I studie III framkom långsiktiga positiva effekter av att delta i MBM kursen avseende i två dimensioner av empatisk förmåga (Personal distress och Empatic concern) bland läkarstudenterna, samt avseende upplevd stressnivå (perceived stress) och empati (personal distress) bland sjuksköterskestudenterna. I studie IV framkom att MBM kursen kan ses som ”en väg till inre medvetenhet och stöd till att knyta an till andra och den omgivande världen” vidare identifierades temana: ”en förmåga till en mer medveten närvaro”, ”en ökad uppfattningsförmåga och inre medvetenhet” samt ”att knyta an till andra människor på en djupare nivå”. Slutsats Utifrån resultaten i avhandlingens explorativa (I, II) del är slutsatsen att de observerade positiva attityderna, och uppfattningarna bland vårdgivare avseende IM och det nyutvecklade hälsobegreppet kan ses som viktiga facilitatorer för ytterligare implementering av IM i det Nederländska hälso- och sjukvårdssystemet. Vidare, den ökade förmågan att hantera stress, utveckla empatisk förmåga och mer öppenhet för nya perspektiv på hälsa och behandlingsalternativ hos läkar- och sjuksköterskestudenter efter deltagande i en MBM kurs (implementeringsdelen i denna avhandling, III, IV), stöttar antagandet att kursen kan ses som ett användbart verktyg för att understödja en mer integrativ vårdansats bland framtida vårdpersonal.

Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 3 i tryck, delarbete 4 inskickat.

At the time of the doctoral defence the following papers were unpublished: paper 3 in press, paper 4 submitted.

Many organisations now strive to achieve excellence in various aspects of occupational health and safety. Benchmarking of the techniques and approaches of other organisations is becoming a popular way of bridging gaps and seeking to achieve high levels of performance. There exist many sources of guidance in the form of external and internal standards, regulations, codes of practice, publications by professional institutions and similar. However, there are clear shortfalls in terms of tools and processes needed to identify areas of opportunity and to overcome barriers to the efficient transfer of ideas and techniques from one enterprise to another. This is true for all organisations, but particularly so for small/medium sized facilities with limited resources and expertise. This study has sought to develop and test new tools and processes to make benchmarking activity and the transfer of technology, ideas and approaches more efficient and meaningful. It has drawn heavily from state-of-the-art management theory and has sought to establish the linkage between the people factor, the workplace environment factor and the organisation of work factor as they contribute to workplace health and safety performance. It has used qualitative inquiry methodologies and an approach based on personal contact and insight, as expressed by Patton (1990, p. 46), to generate data. The fieldwork component of the study was conducted at eight mining, mineral processing and related industry sites within Western Australia. The subject of the study was the facility's processes and practices in regard to the management of hazardous materials. This was chosen partly because chemical-induced injury and disease remain a significant problem for workers in industry (Winder, 1999b, p. 168) and partly because of its complexity and degree of difficulty. Data collection was based on the three qualitative inquiry methods, namely in-depth, open-ended interviews with the Site Manager and the Site Occupational Health and Safety (OHS) Professional, direct observation and review of written documents. Also tested was the assumption that if the materials developed during the study can be applied successfully in the area of hazardous materials, then other less complex areas under the OHS umbrella could be approached with confidence. There is potential for the tools and processes developed and evaluated in this work to be used widely in the transfer of best practice, that is, to be deployed beyond the hazardous substances focus of this study and beyond the Mining Industry of Western Australia. Study outcomes and the new materials that have been generated will assist with the selection of benchmarking partners and will help to identify "pockets of excellence" for focused attention. This will encourage and assist organisations to take steps towards identifying and implementing Industry best practice in the element of interest. There is potential for study outcomes to impact positively on OHS practices within many organisations - and thereby to reduce the personal and societal cost of injury and illness outcomes associated with the use of hazardous materials at work.

Aim: The purpose of this study carried out in Perth, Western Australia was to examine the effect of mindfulness training on workers in a university setting, by assessing the impact of mindfulness training on their sense of wellbeing, happiness, positivity and level of engagement in their jobs. Method: Participants (n = 54) were recruited through the Edith Cowan University staff Health and Wellness Program, Live Life Longer and randomly allocated into two groups of 27. Both groups were invited to take part in 6 weeks of mindfulness training with staggered starts, group 2 began once group 1 had completed the training. There were no exclusion criteria. The training was adapted from the Mindfulness Based Stress Reduction program, and was delivered for one hour each week. The program included a 4-hour retreat on the penultimate Saturday. Quantitative testing was carried out at six week intervals: (T1) at baseline before either group received training; (T2) after group 1 finished the training and group 2 was about to commence; (T3) immediately after group 2 had completed which was a 6 week follow-up for group 1; and (T4) 6 weeks later as a follow up for both groups. Results: The program suffered from high drop-out, with less than half of the original cohort (n=25) participating in four or more sessions of the 6-week program. This is likely to have impacted upon the statistical power of the study and no statistically significant differences were observed between groups: Wellbeing (F (1) = 2.142, p = 0.157); Happiness (F (1) – 1.152, p = .294); Positivity (F (1) = .625 p = .437); Engagement (F (1) = 2.380, p = .137) and Mindfulness (F (1) = .790, p = .383). Conclusion: This study did not show any significant differences in the variables of: wellbeing, happiness, positivity or engagement in work. However other studies have shown significant benefits for organisations and employees in mindfulness interventions in the workplace. A small sample size was a limitation of this study. To validate results and be able to generalise findings larger longitudinal studies should be carried out. Retention rate was an issue in this study and in future, strategies need to be employed to ensure sustainability of the training program and reduce attrition rate. Other modes of delivery of intervention such as using an online platform may increase participation rates. Being able to carry out mindfulness training at convenient times may be more attractive to employees

This research study investigates the concept of workplace information literacy (IL) theoretically and empirically, focusing on the connections between information literacy and knowledge management (KM). This dissertation examines the relevance and applicability of current IL frameworks in a workplace environment by means of a review of the literature, a review of NHS Scotland documentation on its KM initiatives, and a phenomenographic study undertaken with frontline staff at NHS24, a nurse-led, 24/7 service of NHS Scotland that provides over-the-phone consultation and health information. For that study, a working definition of IL as ‘effective information use’ was employed. The concept of information literacy has been developed mainly within librarianship, researched mainly within educational contexts and focused on individual competence in information use. While its application to workplace environments has been assumed, comparatively little research has been done into workplace situations. On the other hand, the concept of knowledge management is directed at a wider organizational level. However, while there is a clear focus in the KM literature on the value of information and its importance for organizations, little attention has been paid to the theoretical and empirical developments of Library and Information Science (LIS) relative to information behaviour and effective information use. The findings of this research identified limitations in the current IL frameworks, notably the lack of consideration for people’s exchanges of knowledge and information and of the social sense making that influences information interpretation and application. The findings endorse views of learning and information use grounded in socio-constructive perspectives and a consideration of context as situated practice. The conclusions suggest the need for more collaboration between studies of IL and information behaviour, and for LIS research to focus more on workplace studies and knowledge management.

Globally, there is a shortage of professional nurses, which compromises the rendering of Health Care performance worldwide. South Africa has the added challenge of a dual Health Care system where there is a large disparity in financial resources, service levels and workload between private and public hospitals, which leads to public hospitals in rural areas failing to attract and retain professional nurses. The purpose of this study is to determine the relationships between three variables from the Positive Organisational Scholarship paradigm namely Workplace Trust, Organisational Citizenship Behaviour and Workplace Well-being which is researched amongst professional nurses in the private and public sectors in both the rural and urban areas in two districts in the Eastern Cape Province. The ultimate aim of the study is to propose interventions of how hospitals can improve the work environment in order to attract and to retain professional nurses. It is also anticipated that the results of the research will contribute to the body of research about Positive Organisational Scholarship (POS). The Workplace Trust Survey (WTS), Organisational Citizenship Level Scale (OCLS) and the Workplace Well-being Questionnaire (WWQ) were integrated into a single selfadministered questionnaire to measure the existence of the variables. The questionnaire also included questions relating to demographic factors. In order to confirm the reliability of the measuring instruments, an Exploratory Analysis was done, a Scree test was applied and a Principal Axis Factor Analysis was conducted. Finally, an Item-reliability Analysis on each factor was administered. The WTS and WWQ revealed sound factorial validity and was considered to be compatible with a South African sample, but the OCLS indicated poor construct validity. Relationships between the variables were analysed by applying a Pearson Productmoment Correlation Analysis in SPSS. T-tests, Analysis of Variance (ANOVA) and the Tukey HSD test was utilized to determine the potential influence of demographic characteristics on the variables. Several interesting relationships between variables and sub-variables were identified. The study concludes with proposed interventions needed to retain professional nurses in hospitals. The limitations of the study as well as recommendations for further research is briefly noted.

The purpose of this study was to explore Zohar’s Multi-Climate Framework for Occupational Safety to determine the effects of staff nurse perceptions of safety priorities in their organization (safety climate) and their work ownership climate (Magnet Hospital designation) on safety citizenship behaviors viewed as in role or extra role. Safety citizenship behaviors are described as behaviors that go beyond the job description to ensure safety. Participants from a convenience sample of three Magnet designated community hospitals in New England completed three scales (Zohar’s Safety Climate Questionnaire, Essentials of Magnetism II and the Safety Citizenship Role Definitions Scale) representing the study variables via an online survey platform. Multivariate analysis of covariance informed the results. Findings include a positive unadjusted relationship between safety climate and work ownership climate (rs=.492, pF (1, 86) = 8.4, p=.005, N=92), controlling for work ownership climate and hospital. Implications include support for a continued focus on better understanding the importance of a positive nursing work environment, a characteristic shared by Magnet designated hospitals, on the presence of safety citizenship behaviors in the acute care environment. A professional work environment should be considered as an important factor in reducing errors in the acute care setting.

Protecting the wellbeing of the Australian mental health workforce has become important as demands on health services increase and resources are stretched. A number of studies show burnout to be a significant issue in this sector despite decades of research on its causes and widespread professional awareness of it. This thesis proposes an explanation for this paradox in human perceptual processes encouraging mental health professionals and managers to minimise recognition of, and response to, burnout. So far there has been little systematic study of employees’ beliefs and perceptions concerning burnout. A review of social perception research, particularly studies of attribution theory, identified a number of human perceptual biases that can influence a person’s perception of his or her health and the need to take remedial action. These are predicted to cause mental health professionals to underestimate the risks and consequences of burnout and prevent them from acknowledging it or seeking help. Despite good objective knowledge of work stress, professionals may misperceive their own vulnerability and continue working to the point of emotional or physical exhaustion. This study takes a phenomenological perspective, seeking to understand professionals’ perceptions and beliefs about burnout and how professional and organisational cultures influence these. Fifty-five mental health professionals responded to a survey asking open-ended questions about their beliefs, attitudes and knowledge of burnout and wellbeing at work. Twelve participants were also interviewed. Respondents were mental health nurses, psychologists, mental health occupational therapists, social workers, psychiatrists or counsellors. Responses were analysed and organised into themes using an inductive approach, linking conclusions as closely as possible to participants’ perspectives. The findings show that professionals’ propensity to address symptoms of burnout is affected by their perceptions of whether managers would provide assistance, the stigma attached to burnout by colleagues or managers, and a tendency to self-blame. Their responses appear to be influenced by the perceptual biases predicted in attribution theory, along with a sense of personal self-esteem strongly tied to professional identity, iii stress-induced cognitive deficits and certain values common in professional or organisational cultures. Together, these factors can reduce professionals’ ability to recognise burnout in both themselves and others. This study contributes to the field by highlighting the role of mental health professionals’ perceptions in explaining the prevalence of burnout in organisations that have the professional resources to avoid it. Common biases in the perception of self or others can cause professionals to downplay their symptoms or use self-blame as an excuse to avoid seeking help while continuing to practice to the detriment of their health, clients and organisation. Organisational cultures and management practices may consciously or unconsciously reinforce these tendencies, along with stigma from colleagues and professional cultures. The findings suggest that the mental health sector should move beyond the pervasive view of burnout as primarily a problem that frontline professionals themselves should detect and respond to. Supervisors and colleagues should work together as a professional community or team, supporting members when they can no longer support themselves. This requires managers, professionals, training institutions and professional bodies to better understand how burnout is created or exacerbated by common human perceptual processes.

Thesis (MPhil)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: The study investigated implementation of HIV/AIDS policy by senior management in Youngsfield military base. Some of the aspects evaluated included training concerning HIV, campaigns, allocation of budget to manage HIV and knowledge of policy by management. Self-administered questionnaires were used as a method of collecting data. The respondents included in the study ages ranged between 25-59 years. The majority of the respondents did not have any problem in completing questionnaires. Results revealed that involvement of headquarters in allocating funds to acquire training aids, distribution of pamphlets and other information educating personnel insufficient, poor implementation of workplace HIV/AIDS policy by management on all levels, lack of programs dealing with HIV/AIDS and lack of HIV/AIDS policy knowledge by management to lesser extent. Recommendations of this study includes aspects dealing with HIV/AIDS workplace programs, importance of occupational health and safety, addressing stigma and discrimination, absenteeism, HIV/AIDS training and most importantly campaigns throughout the year.
AFRIKAANSE OPSOMMING: Die doel van hierdie navorsing was om die implementering van die beleidsdokument wat handel oor MIV/Vigs in die werksplek deur die senior bestuur in Youngsfield militere basis te ondersoek. Van die aspekte wat die navorser ondersoek het is MIV/Vigs bewusmakingveldtogte, beskikbaarheid van fondse en kennis van die Suid Afrikaanse Nationale Weermag beleidsdocument wat handel oor MIV/Vigs in die werksplek. Studievraelyste is aan respondente uitgedeel. Respondente wat aan die studie deelgeneem het se ouderdome wissel tussen 25 en 59 jaar. Die grootste getal deelnemers het geen beswaar aangeteken om die vraelyste te voltooi nie. Die grootste getal van respondente het aangedui dat die fondse wat beskikbaar gestel word onvoldoende is om die boodskap oor die gevare van MIV/Vigs te versprei. Daar is verder bevind dat belangrike aspekte soos biljette, pamflette, video opnames en getikte material nie versprei kan as gevolg van tekort aan fondse. MIV/Vigs beleid is beskikbaar in militere basisse van die Suid Afrikaanse Nationale Weermag. Die enigste tekort is die implementering daarvan. Die aanbevelings wat bevind is deur die studie sluit in MIV/Vigs programme in die werkplek, die aanspreek van stigma en diskriminasie, afwesigheid weens kroniese siektes wat MIV/Vigs insluit en hantering van ongevalle in die werkplek.

This thesis applied a novel interdisciplinary approach for pharmacovigilance to examine the use of complementary and integrative medicine (CIM), focusing on herbal remedies, to manage pediatric attention-deficit hyperactivity disorder (ADHD). The safety and potential risk of herb-drug interactions in ADHD management were first evaluated through an assessment of available information on the safety and efficacy of natural health products (NHPs) commonly used by ADHD patients as a means of identifying knowledge gaps. A clinical questionnaire was administered to caregivers of pediatric patients with ADHD to determine the factors and related outcomes of CIM use, including adverse events. A systematic search was conducted to further identify clinical adverse events involving herbal remedies and ADHD drugs to determine causal links to herb-drug interactions. In vitro analysis of identified herbal remedies was conducted to determine their potential for pharmacokinetic interactions, specifically on carboxylesterase-1 (CES1) mediated metabolism. The presented research builds on otherwise scarce evidence of the safety of herbal remedies for ADHD, particularly with respect to herb-drug interactions and adverse events (AEs) associated with concurrent use of NHPs and ADHD prescription drugs. Beyond studies conducted on the pharmacokinetic safety of herbal remedies through the cytochrome P450 pathways that metabolize some ADHD drugs, including amphetamine, atomoxetine and guanfacine, few data were available for CES1, which metabolizes methylphenidate, the first line of drug used to manage ADHD. The clinical questionnaire revealed that 40% of patients had used CIM and confirmed the use of a variety of CIM. Moreover, the majority of CIM users were also concurrently taking ADHD medication, and eight mild adverse events were self-reported. The systematic search on the adverse event reporting system highlighted a potential NHP-drug interaction between methylphenidate and St. John’s wort, and the overall poor quality of NHP-related adverse event reports. As a follow-up from the adverse event results, various commercial St. John’s wort products showed variable inhibition of recombinant human CES1 in vitro. Although the concentration of marker phytochemicals was not correlated to inhibition, hyperforin showed stronger activity than hypericin and quercetin. The preliminary in vitro investigation revealed that the herbal remedies used by ADHD patients have the potential to interact with CES1 mediated metabolism, with Rhodiola rosea identified as the most potent inhibitor. Further investigation on various commercial products of Rhodiola rosea revealed both reversible and irreversible inhibition of recombinant CES1. However, the inhibition was not dependent on the concentration of marker phytochemicals, and rosarin, rosavin, rosin, and salidroside were not potent inhibitors of recombinant CES1. Moreover, a commercial Rhodiola rosea extract showed concentration-dependent inhibition of human liver microsome meditated metabolism of methylphenidate. Overall, results from this thesis suggest potential risk from use of NHPs concurrently with conventional medicine used to manage ADHD. Improved evidence and pharmacovigilance for the use of NHPs in a pediatric population is warranted.

Bakgrunn: Medarbeiderundersøkelsen i 2006 ved anestesiavdelingen seksjon 2, Rikshospitalet iOslo, avdekket dårlige skår for anestesisykepleieres mulighet til å påvirke sin egen arbeidssituasjon. Hensikt: Hensikten med studien var å kartlegge faktorer i anestesisykepleierens arbeidssituasjon som oppleves som helsefremmende og å finne ut på hvilken måte ledelsen kunne bidra til et mer helsefremmende arbeidsmiljø. Nytteverdien av studien blir at de faktorer som fremmer helse foranestesisykepleiere blir synliggjort overfor ledelsen. Metode: Det ble brukt en kvalitativ metode med intervjuer av fjorten yrkesaktive anestesisykepleiereved seks forskjellige anestesiavdelinger. En modifisert Grounded Theory ble benyttet somanalysemetode. Resultat: Analysen av intervjuene resulterte i kjernekategorien: Samarbeid på godt og vondt,anestesisykepleierens lodd i yrkeslivet og tre kategorier: Ledelsen som premissleverandør; Trivsel iet operasjonsmiljø; Rolleklarhet.Kjernekategorien belyser den koordinerende helheten som anestesisykepleieren i varetar i forhold tilpasient og andre profesjoner. Den beskriver både en stor tilfredsstillelse i arbeidssammenheng men samtidig gir den en anelse om at uoverensstemmelser kan forekomme. Ledelse utkrystalliserte segsom en viktig faktor for å tilrettelegge for et helsefremmende arbeidsmiljø, slik at grunnleggende behov ble tilfredsstilt. Produksjonspress og kommunikasjonsvansker i forhold til de nære samarbeidspartnere var faktorer som opplevdes som demotiverende og kunne noen ganger skapemistillit. Kollegastøtte spilte en avgjørende rolle i anestesisykepleiernes opplevelse av et godtarbeidsmiljø. En sammenfattende modell ble utviklet som beskriver grunnforutsetninger for utøvelseav sitt fag, hinder og begrensninger, opplevelsen av optimal pasientbehandling og ledelsens overordnede påvirkningspotensiale på både de positive og negative faktorene. Konklusjoner: Studien viser at flere viktige faktorer medvirker til at arbeidsmiljøet oppleves som helsefremmende for anestesisykepleiere. Ledelsen er en viktig faktor og den bør være mer aktiv vedå gi forsvarlige rammer for drift, og i større grad initiere helsefremmende tiltak og motivere til bedresamarbeid mellom profesjonene. Andre viktige faktorer for trivselen var det selvstendige arbeidet og det tverrfaglige samarbeidet om pasienten.
Background: The 2006 employee survey from Anaesthesia Unit 2, at Oslo’s Rikshospital, revealedlow scores regarding anaesthesia nurses` opportunity to influence their own work situation. Purpose: This study aimed to examine work factors that anaesthesia nurses perceive health promoting and to analyze how hospital leadership could initiate a healthier work environment. The value of this assessment is that factors that promote a healthy work environment for anaesthesia nurses will become visible to department management. Method: A qualitative method was used, which included interviews with fourteen anaesthesianurses, working in six different departments. A modified Grounded Theory was applied as a methodfor analysis. Result: Analysis of the interviews yielded a core category: Cooperation for Better or Worse-Anaesthesia Nurses` “Ticket” in the Workplace, and three categories: Leadership, An Organizer of Conditions; Well-being in an Operations Environment and Clarity of Roles.The core category illustrates the coordinated entirety that anaesthesia nurses consider a safeguard inrelation to the patients and other professions. Nurses described great satisfaction in their work aswell as an inkling that differences can occur. Leadership was crystallized as an important factor infacilitating a healthy working environment that satisfies basic personal and professional needs. The respondents perceived production pressure and communication difficulties with close collaborators,as demotivators that sometimes caused lack of trust. Collegial support was a crucial factor in creatingthe perception of a good working environment. A model was developed, which illustrates the basic conditions of practicing the profession, obstacles and restrictions, how nurses experience optimal patient care and fundamental and potential influence of department leadership on both positive and negative factors. Conclusions: The study shows that several important factors contribute to a healthy working environment for the anaesthesia nurses. Leadership should work more actively toward developing ajustifiable framework of management and initiating health promoting efforts that motivate better cooperation between team members. Other important factors for well-being in the workplace included independent work and interdisciplinary collaboration around patient care.

ISBN 978-91-85721-75-7

This study examined the effects of a mindfulness-based coaching intervention on perception and emotional regulation shifts related to workplace stressors (internal and external), quality of worklife, interpersonal relationships, and general sense of well-being of high-level executives (HLE) who indicated a desire to improve these areas of their worklife.

Participants in this study were six HLEs, responsible for managing the direction and change strategies of the organization or department under their charge, who supervise, manage others, and work in dynamic environments. Participants identified negative stress response and emotional regulation as well as being focused on the past and the future to be a challenge in their daily work lives.

Kabat-Zinn (2012) posited that mindfulness practice can provide the practitioner with a true embracing of a deeper sense of self and others, which can permeate life and transform the relationship to how one thinks, feels and works. Marlatt and Kristeller (1999) described mindfulness as "bringing one's complete attention to the present experience on a moment to moment basis" (p. 9).

The study included an 8-week mindfulness coaching intervention, pre and post questionnaires, semi-structured interviews. Mindfulness Based Stress Reduction (MBSR), HeartMath Mindful-Hearth Intelligence workbook, tools, exercises and practice were used within a coaching frame work.

A multiple case study design was used and a thematic analysis of the coaching intervention was conducted. The analysis detailed themes and patterns in shifts and changes in perception, emotional regulation around stress response, relationships, and general sense of well-being.

The study elucidated the impact of these interventions on HLEs. Several themes emerged as assets for participants during the intervention, specifically, work stress management, heightened awareness, and acceptance. Suggestion for further research would be to explore the hardiness of the process of acceptance in deepening the impact of the other central themes. An unanticipated result which was explored was the extent to which participants came to understand with kindness and curiosity the negative aspects of nondisclosure within their work culture.

Abstract Several companies work in shared workplaces and each company has different requirements for health (H), safety (S), environment (E) and quality (Q). Many globally operating companies have defined their own corporate requirements. Requirements in local national legislation and insurance policies are creating more challenges. The various requirements affect how HSEQ management is implemented in changing, complex, and heterogeneous working environments. The aim of the thesis was to describe HSEQ management development in Northern Finnish process industry companies (N = 6) and their company network in the shared workplaces context during the past 20 years. The study also describes the current state of HS and partly EQ [HS(EQ)] management practices and tools in a global steel company. An important objective was to make recommendations on how to continuously improve and develop HS(EQ) issues. A mixed methods approach (interview, document study, questionnaire, benchmarking and -learning, SWOT analysis) were used in the case study. HSEQ Assessment Procedure―a type of integrated management system tool―was developed to evaluate supplying companies’ HSEQ performance in shared workplaces. It was selected as the main method on one site of the global steel company. The global steel company’s HS management system was based on OHSAS 18001 with HS vision and principles, development plan, internal standards and performance indicators. Lost time injury frequency rate (LTIFR) and HSEQ AP performance showed positive trends. Both corporate HS requirements and local HS(EQ) practices provided adequate tools for a safety culture and HS(EQ) performance development. Recommendations were made regarding HS(EQ) management tools, practices and indicators in shared workplaces operating globally. The focus should be on preventive actions, such as leading performance indicators and creating a uniform safety culture for shared workplaces with a sustainable foundation. The development should be supported by the commitment and participative development of every organisational level. Learning from internal good practices and external benchmarking are valuable methods for this purpose. HSEQ management, change management, internal and external standardisation and information technology systems should be exploited to support this goal
Tiivistelmä Yhteisellä työpaikalla työskentelee useita yrityksiä, jotka ovat määrittäneet omat vaatimuksensa työterveydelle (H), työturvallisuudelle (S), ympäristölle (E) ja laadulle (Q). Lisäksi kansainvälisillä yrityksillä, kansallisessa lainsäädännössä ja vakuutusyhtiöillä on omat vaatimuksensa, jotka luovat entistä haasteellisemman työympäristön. Monenlaiset vaatimukset vaikuttavat siihen, kuinka HSEQ-johtaminen on toteutettu muuttuvassa, monimutkaisessa ja epäyhtenäisessä työympäristössä. Tutkimuksessa kuvattiin HSEQ-johtamisen kehittymistä pohjoissuomalaisissa prosessiteollisuuden yrityksissä (N=6) ja niiden yritysverkostossa, yhteisellä työpaikalla, viimeisen 20 vuoden aikana. Lisäksi kuvattiin HS ja osittain myös EQ [HS(EQ)] -johtamisen menetelmien ja työkalujen nykytilaa kansainvälisessä terästeollisuuden yrityksessä, sekä kehitystarpeita tavoiteltaessa HS(EQ)-johtamisen huippuosaamista. Tutkimus toteutettiin monimenetelmällisenä tapaustutkimuksena: haastattelu, dokumenttien tutkimus, kysely, esikuva-analyysi, SWOT-analyysi. HSEQ-arviointi on kehitetty yhteisille työpaikoille toimittajayritysten HSEQ-suorituskyvyn arviointiin hyödyntäen integroidun johtamisjärjestelmän periaatetta, ja se valittiin yhdeksi päämenetelmäksi tutkimuksen kohteena olevalle yhteiselle työpaikalle. Tutkimuksen kohteena olevan terästeollisuuden alan yrityksen HS-johtaminen perustui OHSAS 18001-järjestelmään. Visio, periaatteet, toimintasuunnitelma, sisäiset standardit ja suorituskyvyn mittarit muodostivat konsernin HS-järjestelmän. Tapaturmataajuuden ja HSEQ-arvioinnin tulosten perustella kehitys on ollut positiivista. Konsernin HS-vaatimukset ja paikalliset HS(EQ)-käytännöt antoivat kohtuulliset työkalut turvallisuuskulttuurin ja HS(EQ)-suorituskyvyn kehittämiselle. Suositukset koskivat yhteisillä työpaikoilla ja kansainvälisessä työympäristössä toimivien organisaatioiden HS(EQ)-johtamisen työkaluja, käytäntöjä ja mittareita. Pitäisi keskittyä ennakointiin, kuten ennakoiviin turvallisuusmittareihin ja luomaan yhtenäinen kestävä turvallisuuskulttuuri yhteiselle työpaikalle. Jokaisen organisaatiotason tulisi sitoutua kehittämiseen hyödyntäen osallistuvaa kehittämistä. Sisäisillä hyvillä käytännöillä ja ulkoisella esikuva-analyysilla voidaan tukea kehittämistä. HSEQ-johtamista, muutoksenhallintaa, sisäistä ja ulkoista standardointia sekä tietoteknisiä järjestelmiä pitäisi hyödyntää

Bakgrund: Sjuksköterskeyrket har genomgått stora förändringar under de senaste decennierna. Sjuksköterskan förväntas att vara en länk mellan samtliga instanser i vårdkedjan i en organisation där omorganiseringar sker och arbetsvillkor ändras. Stress är ett inbyggt fenomen i vårdarbetet och är precis som hälsobegreppet högst individuellt och komplext. Sjuksköterskan behöver ta hand om den egna hälsan för att inte vården av andra ska äventyras. För att kunna göra detta har sjuksköterskan ett ansvar men en förutsättning för detta är dock att organisation, ledning och arbetsplats är utformad så att det är möjligt för sjuksköterskan att upprätthålla hälsa. Syfte: Syftet var att beskriva sjuksköterskans upplevelse av sin arbetssituation för att förstå hur den påverkar den egna hälsan Metod: Examensarbetet är en litteraturöversikt. Resultatet grundar sig på nio vetenskapliga artiklar. Vid analysen lästes artiklarna ett flertal gånger och likheter och skillnader identifierades. Resultat: Följande huvudteman utkristalliserades; sjuksköterskans upplevelse av organisation, sjuksköterskans upplevelse av ledning, sjuksköterskans upplevelse av stress samt sjuksköterskans upplevelse av patientmötet. Det andra huvudtemat har tre underteman; att inte bli lyssnad på, att inte få stöd och att få stöd. Huvudtema tre har två underteman; negativ stress och positiv stress som utvecklar. Diskussion: Resultatet diskuterades utifrån transition som teoretisk utgångspunkt. De intervjuade sjuksköterskorna visade sig i stor utsträckning har likartade uppfattningar om sin arbetssituation som i andra studier. De upplevde en hög grad stress och ett missnöje kring ledning och organisation på sin arbetsplats vilket visar på brister i ledning och organisation som påverkar på hälsan.
Background: Nursing profession has undergone major changes in recent decades. The nurse is expected to be a link between all parts in the care chain in an organization where reorganization takes place and working conditions are continuously changing. Stress is an internal phenomenon in care work and is just as the concept of health of highly individual and complex. The nurse needs to take care of her/his own health in order to the care of patients. While the nurse has a responsibility the prerequisite for being capable to provide good care is that the organization, management and workplace is designed to make it possible for the nurse to maintain health. Aim: The aim was to describe nurses' experiences of their work situation in order to understand how it affects their own health. Method: The thesis is a literature review. The result is based on nine pieces of scientific articles. The articels were read several times and the similarities and differences were identified. Results: The following main themes emerged; nurse's experience of the organization, the nurse's experience of management, the nurse's experience of stress and nurses' experience of meeting the patient. The second main theme has three sub-themes; not to be listened to, not to get support and to get support. The main theme of three has two sub-themes; negative stress and positive stress that develops. Discussions: The results were discussed using transition as a theoretical base. The nurses had rather similar views about their work situation as showed also in other studies. They experienced a high degree of stress and dissatisfaction with the management and organization in their workplace that highlights the deficiencies in management, and organization that have strong impact on health.

A sociedade, em suas múltiplas dimensões, tem estado em constante construção de uma nova realidade. Valores, ideias e paradigmas se a lternam em \"des\" e \"reconstrução\" daquilo que a sustenta e norteia. A Reforma Sanitária se torna um movimento específico, porém contextualizado num processo de redemocratiz ação política da sociedade brasileira. Esse movimento, além de representar uma luta específica pelo modelo de atenção à saúde, também é parte de uma totalidade, uma vez que consolidava, na saúde, os direitos democráticos debatidos por diversos setores da sociedade brasileira. A busca por um novo desenho do cuidado da saúde pela sociedade se dá a partir dos princípios e dire trizes fundamentais do Sistema Único de Saúde, uma vez que estes, além de garantir um novo modelo de atenção, possibilitariam as bases para um modelo de gestão mais participativo que daria condições de continuidade deste movimento. Nesse contexto, a enfermagem carece de um processo de atualização em seus conceitos e arranjos. Pr ecisa permitir que as transformações sociais colaborem na construção do perfil profissional que se necessita para que se garanta a \"continuidade\" no processo natural de mudanças das políticas públicas que requerem, dentre outras, \"flexibilidade e criatividade\" por parte dos trabalhadores. Este estudo teve como objetivo analisar a Gestão Participativa, no contexto do Sistema Único de Saúde, à luz das evidências científicas, visando a identificação de categorias relevantes na construção do processo do trabalho em enfermagem. Para atender aos objetivos deste estudo, foi realizada a revisão integrativa da lite ratura existente que propo rcionou um aprofundamento no conhecimento dessa temática e deu condições para o desenvolvimento de um conceito próprio. A leitura dos artigos selecionados seguiu a proposta da análise temática de conteúdo, segundo Minayo, e alguns temas emergiram da leitura, de modo que eles representam alguns aspectos importantes do Trabalho em Enfermagem no contexto da Gestão Participativa. Desta forma, identificou-se os seguintes temas nas amostras selecionadas: Reorientação da Prática Assistencial, Sobrecarga de Trabalho, Gestão Ética, Participação, Liderança, Administração de Conflitos, Qualificação Profissional, Formação Política e Flexibilização das Relações. Conclui-se que a enfermagem necessita de uma reorientação sistemática de seu processo de trabalho de modo que possa se alinhar com a política pública da Gestão Participativa e alcançar os benefícios desta gestão no perfil de seus trabalhadores.
The society, in its multiple dimensions, has been in constant construction of a new reality. Values, ideas and paradigms alternate in \"des\" and \"reconstruction\" of what sustains and guides. The Sanitary Reform becomes a particul ar movement, but contextualized in a process of political democratization of Brazilian society. This movement represents a struggle for specific model of health care and is also part of a totality, since consolidated in health, democratic rights debated by various sectors of Brazilian society. The search for a new design of health care by society starts from the fundame ntal principles and guidelines of the Unified Health System, since these, in addition to ensure a new model of care, would allow the foundation for a more participatory management model which would enable the continuation of this movement. In this context, nursing lacks a process to update its concepts and arrangements and needs to allow social change to collaborate in building the profile that is needed to ensure the \"continuity\" in the natural process of changing public policies that require, among other things, \"fle xibility and creativity\" by wo rkers. This study aimed to analyze the participatory management in the cont ext of the Unified Health System, in light of the scientific evidence for the identification of relevant categories in the construction process of nursing work. To meet the objectives of this study, we performed an integrative review of existing literature that provided a deeper knowle dge of thematic and gave conditions for the development of a specific concept. The reading of the articles followed the proposal of thematic content analysis, by Minayo, and some themes emerged from the reading, so that they represent some important aspects of nursing work in the context of Participatory Management. Thus, we identified the following themes in the selected samples: Reorientation of Care Practice, Work Overload, Ethics Ma nagement, Participation, Leadership, Conflict Management, Professional Qualification, Political Education, and Flexibilization of the Relations. It is concluded that nursing requires a systematic reorientation of their work process, so that it can align itself with the public policy of participatory management and achieve the benefits of this management in the profile of their workers.

Working climate is an important subject in management research. The purpose of this research is to study the characteristics of an LGBT-friendly working climate. This research is based on Queer theory and Taste-based Discrimination theory, and follows the qualitative analysis method of interpretivism. The results of the descriptive survey and interviews show that employees’ understanding of LGBTQ policies and identities is very important for building an inclusive working climate. Organizations can use these findings to better protect employees’ welfare and establish an equal workplace environment.

Home care nurses (HCNs) have reported a high rate of exposure to work-related injuries (WRIs). Nurses are challenged by the multidimensional problems associated with home care safety. These contextual risk factors increase the physical and social health problems of health care workers and of community suffering as a whole. This quantitative, cross-sectional study was designed to examine the relationship between the organization-related factors (ORFs) and the environment-related factors (ERFs) and their influences on safety behaviors (SBs) and the WRIs of HCNs. The PRECEDE framework was used to guide the study. Self-reported data were obtained from 74 home health care (HHC) nurses using the Safety Home Care Nursing questionnaire. A linear regression model was applied to determine the nature of the association between the independent variables and dependents variables. Findings showed the ORFs demonstrate a stronger effect on the SBs than the impact of the ERFs. The management commitment and the home-based care significantly affected the SBs. The supervisory support and safety access to a client's home were decreasing the WRIs. Therefore, the integration of efforts: The management and leadership of the health organization, the health care providers, and the clients’ family would improve safety of HHC. This study is expected to help develop safety strategies for home care and thus attempt to minimize WRIs among HCNs. Nurses free of injuries are able to provide a quality of care and improve patients’ health outcomes that in turn have an effect on reducing community suffering and financial costs.

Sjukfrånvaron och personalomsättningen är hög inom vård- och omsorgssektorn och medarbetarnas arbetssituation är många gånger krävande. Ändå har vissa verksamheter lyckats med att upprätthålla låga sjuktal. Vad föranleder att medarbetare inom dessa verksamheter håller sig friska? Syftet med studien är att undersöka vilka åtgärder medarbetare inom den kommunala äldreomsorgen vidtar för att hålla sig friska och vad de anser bidrar till friskare arbetsplatser och mer hälsofrämjande och hållbar arbetsmiljö. Med hjälp av innehållsanalys har intervjusvar från nio medarbetare granskats. Resultatet pekar på att medarbetarna har utarbetat strategier samt besitter ett slags inre driv som hjälper dem hantera sin arbetssituation. Det som förhöjer arbetsglädjen, inger trygghetskänsla och skapar trivsel är arbetsgruppen. Arbetsgruppens betydelse är central i resultatet. Genom att skapa rutiner, ställa upp på varandra och ha roligt tillsammans lyckas arbetsgruppen med gemensamma krafter axla vardagens utmaningar. Ledarskapet däremot anses relativt osynligt. En avvägd balans mellan återhämtning och stimulerande sysselsättning på fritiden genererar ny energi som medarbetarna anser är en viktig förutsättning för att klara av arbetsdagen med hälsan i behåll. Ambitionen med studien är att besvara syftet men även att föra en diskussion kring resultatet utifrån ett hållbarhetsperspektiv. Detta för att den fortsatta verksamhetsutvecklingen inom vård- och omsorgssektorn ska bli så hälsofrämjande och hållbar som möjligt, både för nuvarande och kommande generation.
Sick leave and staff turnover is high in the healthcare system where its professionals work environment is very often demanding. Nonetheless, some organizations have succeeded in maintaining low absence due to sickness. What keeps the personnel in these organizations healthy? The aim of this study is to investigate which strategies employees in the public healthcare system apply to maintain their health and what they acknowledge to be a contributive factor for a healthier workplace and a more health promoting work environment. We have, with content analysis as a working tool, reviewed a total of nine health workers interviews. The result shows that the employees have developed both strategies and acquired a sort of inner drive that helps them to handle their working situation. What improves their happiness at work are the colleagues, that gives them a sense of security and creates comfort. The importance of the working group is central to the result. Through the creation of routines, by helping and having fun together the group succeeds in pushing through day-to-day challenges. Leadership on the other hand is considered to be relatively inexistent. A balance between recovery and stimulating activities contributes in replenishing energy that health workers consider to be key to guarantee a healthier work-life. The ambition with this study is to provide answers regarding the purpose but also serve as a basis for a discussion from a sustainability perspective. This in order to that organizations in the healthcare business continue developing whilst focusing on promoting health and sustainability as much as possible, both for the present and future generations.

Employee absenteeism costs organizations billions of dollars annually in losses in revenue and productivity, temporary labor costs, and low morale. The purpose of this qualitative single case study was to explore the strategies information technology (IT) managers in the manufacturing industry used to reduce employee absenteeism. The theory of planned behavior provided the conceptual framework for the study. Data collection included semistructured interviews with 5 IT managers in Maryland and a review of organizational documents addressing nutritional education information, employee participation rates in health programs, and physical activity. Data were analyzed using compilation, disassembly, reassembly, interpretation, and development of conclusions. Through thematic analysis, 4 themes emerged: workplace wellness and health programs, employee engagement, work-life balance programs, and organizational culture. Findings of this study may be used by IT managers to bring about positive change by reducing employee absences, encouraging employment opportunities, contributing to organizational sustainability, and improving quality of life for community members.

Asplund, L (2007). Systematiskt arbetsmiljöarbete. Nyckelpersonsintervjustudie om uppfattning kring arbetsmiljöarbete, lönsamhet och prioriteringar på en arbetsplats 15 högskolepoäng, Magisterprogrammet. Högskolan i Gävle, Institutionen för Pedagogik, didaktik och psykologi.

Bakgrund

Att arbeta systematiskt med arbetsmiljöarbete är ett krav för alla arbetsgivare enligt svensk arbetsmiljölag. Alla arbetsgivare förväntas göra riskbedömningar och ta fram lösningar för att förebygga olyckor. Det systematiska arbetsmiljöarbetet på arbetsplatsen ska hanteras som en naturlig del i den dagliga verksamheten och omfattar de fysiska, psykologiska och sociala förhållandena i arbetsmiljön.

Syfte:

Att undersöka nyckelpersoners uppfattningar om vad som påverkar prioriteringar av systematiskt arbetsmiljöarbete på ett företag samt studera deras uppfattningar om arbetsmiljöförändring i relation till ökad lönsamhet.

Urval

Inför nyckelpersonsintervjuerna kontaktades personalansvarig som i sin tur valde ut nyckelpersonerna. Chefer, områdesansvariga och skyddsombud intervjuades. Intervjupersonerna valdes ut då en speciell kompetens för området krävdes. Sex av intervjuerna utfördes under en veckas tid på de intervjuades arbetsplats. En kort intervju med skyddsombudet utfördes fyra veckor senare på företaget.

Design och metod

För att besvara frågeställningarna utfördes intervju på sex nyckelpersoner utifrån en intervjuguide. Intervjuerna tog cirka 30 minuter vardera. Halvstrukturerade intervjuer användes. Intervjuerna transkriberades och analyserades och ytterligare en intervju utfördes efteråt med ett skyddsombud. Intervju användes som metod för datainsamlingen som kom att stå för resultatet.

Resultat

Resultatet visar att informanterna anser att det som mest påverkar prioriteringar kring det systematiska arbetsmiljöarbetet på arbetsplatsen är ekonomin och chefer/ledningens inställning. Annat som påverkar är arbetsmiljölagen och koncernens riktlinjer och budget. Sjuk-frånvarouppföljningar görs i en del i sin strävan att uppnå ökad lönsamhet. Arbetsmiljöförändringar som utförts i strävan att nå ökad lönsamhet och bättre arbetsmiljö har mestadels varit av fysisk ergonomisk art.

Slutsatser

Informanterna gav olika information gällande det pågående arbetsmiljöarbetet. De sade att arbetsmiljöarbetet var fortgående och aktivt och de trodde att personalen ansåg att det inte arbetades särskilt mycket med arbetsmiljöarbete. Skyddsombudet ansåg att det gjordes mer än vad personalen trodde. Detta betyder att kommunikationen kan behövs bättras för att de anställda skall få mer insikt om vad som föregår gällande arbetsmiljöarbete och kan bli mer involverad i själva arbetet.

Nyckelord:

Systematiskt arbetsmiljöarbete, lönsamhet, och hälsofrämjandearbete

Asplund, L (2007). Systematic Work Environment Management: Key Informant Interviews about Apprehensions, Priorities and Profitability. Examination paper in Pedagogy, 15 hp. Master’s Programme. University College of Gävle. Department of Education, Curriculum Studies and Psychology.

Background

Every fourth Swedish employee has been found to suffer from some form of work-related ill-health. Legislation, termed Systematic Management of Workplace Environments (SAM), has been enacted to promote optimal physical and psychosocial workplace environments. Em-ployers are obliged to follow the regulations issued by the Swedish Work Environment Au-thority [Arbetetsmiljöverket] and are responsible for operating active workplace environ-ment management plans. Such plans can prevent ill-health and, in some cases, increase the company’s profitability.

Purpose

A medium-sized, retail trade company from in central Sweden was chosen in order to study and analyze how systematic workplace management environment practices were imple-mented in relation to other management priorities and company profitability.

Sample

The key informants were chosen out of the personal manager who was the first contact on the company. Seven key informants, selected on the basis of their knowledge of their com-pany's Systematic Work Environment Management, participated in the study. An additional key informant was later chosen to validate the results. The informant composition was: three informants from middle management, with 5 to 7 years experience of the company, one supervisor (1 year), and three other members of staff (2 and 3 years.) Six qualitative in-terviews were carried out, within the period of one week, in the interviewees' offices. The validating interview was undertaken 4 weeks later, also on the company’s premises.

Design and methods

The company specialized in retail furniture. Non-structured interviews, based on an inter-view guide with 11 open-ended questions, were used. The interviews, lasting about 30 mi-nutes each, were recorded and transcribed. Statements were analyzed for notable differ-ences, similarities, themes and patterns. The statements were then categorized and sub-jected to further analysis.

Results

All the informants felt that the company’s actual practice met the work environment stipula-tions and was on-going. They agreed that workplace environment in general is considered an important issue, but that the company could probably do more to meet the intentions of the work environment legislation. Two specific focal points appeared in the results: ergo-nomic improvement in the workplace and the informants’ aspiration to implement and de-velop a system of caring telephone calls to employees absent through illness.

Conclusions

Management was seen as giving contradictory signals. On the one hand they say that work environment is active and ongoing and on the other hand agree that not enough is being done. The expression of intent does not appear to be matched by actions. Improved educa-tion in systematic workplace environment management would give employees a better un-derstanding of work environment and how systematic workplace management is supposed to operate. The analysis of the informants' suggestions led to a series of proposals for im-provements in workplace environment management strategies. A new plan for employee participation would involve employees being more directly and actively involved with work environment and increase support for the work of the safety representatives.

Keywords:

Systematic Management of Workplace Environments, health and safety codes, profitability, employee participation, muscular-skeletal, psychosocial working envi-ronment, health promotion

This chapter reviews the literature applying health behavior theories to indoor tanning. Few studies have tried to fit full versions of health behavior models to indoor tanning. Theoretical models from the family of theories referred to as the reasoned action approach (e.g., theory of planned behavior, behavioral alternative model, prototype willingness model, etc.) have been most commonly used to study indoor tanning. Results indicate that these models fit indoor tanning data moderately to extremely well. Two lesser known models, problem behavior theory and the terror management health model, have also demonstrated a reasonable fit. Two other common models, the health belief model and social cognitive theory, have never been fully tested with indoor tanning. However, key constructs from these models (e.g., perceived susceptibility and threat, modeling) have been used to understand indoor tanning. Empirical research conducted represents a solid start toward developing strong, comprehensive models of indoor tanning that can guide intervention efforts. This initial work needs to be expanded by conducting longitudinal studies and by including a broader age range in studies because the majority of existing work has focused on young adults. Incorporating findings related to tanning dependency, peer group affiliation, media influences and other constructs into these foundational models will also improve our understanding and ability to develop efficacious interventions to reduce engagement in this health risk behavior.

Skadligt bruk är ett brett begrepp som omfattar många olika former av bruk, till exempel av alkohol, droger eller spel om pengar vilket kan påverka arbetsprestationen negativt hos en arbetstagare. På uppdrag av Folkhälsomyndigheten ville man värdera verkningsgraden av genomförda utbildningsinsatser kopplat till problematiskt spelande. Syftet med den här studien är att kvalitativt utvärdera upplevelser av genomförda utbildningsinsatser som organisationen Alna genomfört kring skadligt bruk med fokus på spelproblem. Tematisk analys användes och datainsamling skedde genom semistrukturerade intervjuer med tio HR-medarbetare, vars fem organisationer ingick i utbildningsprojektet Spel och spelförebyggande insatser för arbetslivet. Resultatet visar att Alnas metoder och verktyg upplevs som effektiva och värdefulla av undersökningsdeltagarna. Vissa hinder för effektiv implementering av uppdaterade policys och riktlinjer identifierades och dessa kunde bestå av tidsbrist, underbemanning eller eftersatt prioritering av spelfrågan. Vidare framgår det att Alnas utbildningsinsatser främjat utformandet av policys och riktlinjer kring skadligt bruk med fokus på spel och spelproblem i organisationerna.
The complex concept regarding harmful use of different nature, could be related to the use of alcohol, drugs or gambling. Such activities could affect the efficiency and productivity of an employee in a workplace environment in a negative way. At the request of the Public Health Agency of Sweden, a group of scientist was given the task to evaluate a project regarding education concerning problematic gambling. The purpose of the current study is to evaluate a project regarding education concerning gambling and gambling prevention, and was carried out by the organization Alna. Thematic analysis was used and collection of data was done with semi structured interviews, with ten HR-employees whose five organisations was included in the project Gambling and gambling preventive efforts directed towards the labour market. The results show that the methods and tools used by Alna is perceived as efficient and valuable by the participants. Some obstacles which works against efficient implementation of updated policies and guidelines were identified and these could consist of time constraints, under staffing or subordinated priority of the gambling issue per se. Furthermore it seems that the education project regarding gambling prevention performed by Alna has contributed to the development of policies and guidelines regarding harmful use of different kinds with focus on the gambling issue.
Utvärdering av projektet Spelförebyggande Insatser för Arbetslivet – Praktisk Tillämpning och utvärdering.