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Leadership, psychosocial work environment, and satisfaction with elder care among care recipients: Analysing their associations and the structural differences between nursing homes and home care
Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Municipal elder care has become increasingly multifaceted, and the quest for quality is a continuing discussion in Swedish elder care. In recent decades, municipalities have prioritized older adults with severe needs. There is also a trend of more elderly individuals receiving care in their own homes. The number of persons 80 years and older will increase by approximately 75 percent between 2015 and 2035. During the same period, the numbers of nursing assistants are likely to decrease. Furthermore, health and social care services have the highest rates of sick leave in Sweden, and the psychosocial work environment plays an important role in reducing sick leave. Perceived support from an organization, leaders and colleagues has been shown to have a positive effect on nursing assistants’ perceptions of the psychosocial work environment in elder care settings. Leadership characteristics or attributes and behaviours have been associated with a healthy work environment. Thus, knowledge regarding the associations between leadership, the psychosocial work environment, and recipient satisfaction in elder care is insufficient.

Aims

The overall aim of this thesis was to explore and describe the associations between leadership, the psychosocial work environment, and recipient satisfaction in municipal elder care, the changes over time in psychosocial work environment, and the difference between nursing homes and home care.

Design and methods

This thesis is based on four cross-sectional studies (I-IV) and one study based on repeated cross-sectional analyses (V). Data from three different surveys were used: the Developmental Leadership Questionnaire (DLQ), the Questionnaire for Psychological and Social Factors at Work (QPS), and a recipient satisfaction survey (based on a National Board of Health and Welfare recipient satisfaction survey). Study I analyses first-line managers’ assessments of their leadership and nursing assistants’ assessments of their first-line managers. Study II analyses the associations between leadership and the psychosocial work environment, study III the associations between psychosocial work environment and recipient satisfaction, and study IV encompasses all three levels, leadership and the psychosocial work environment, and recipient satisfaction. Study V describes changes in the psychosocial work environment between 2007 and 2015.

Results

There are structural differences between nursing homes and home care in the assessments of leadership, the psychosocial work environment, and satisfaction among older people. Linear trends for the period 2007-2015 demonstrate a decline in control at work in both nursing homes and home care and positive trends for stimulus from the work itself. The results also show that nursing assistants in nursing homes rate their psychosocial work environment higher than nursing assistants in home care. Older adults receiving home care report higher satisfaction than those receiving care in nursing homes. In contrast, nursing assistants in home care rate their first-line managers’ leadership and their perceived psychosocial work environment lower than those working in nursing homes. Process-related factors, for example, the association between leadership and the psychosocial work environment, showed that interpersonal factors, such as support from superiors, empowering leadership, human resource primacy, and direct leadership, may impact nursing assistants’ psychosocial work environment in both nursing homes and home care. A better psychosocial work environment among nursing assistants was associated with higher satisfaction among recipients of elder care, except for the recipient satisfaction item staff knowledge, which had negative associations with the psychosocial work environment.

Conclusions and implications for practice

To influence nursing assistants’ performance, to increase recipient satisfaction and to increase quality in eldercare in the long term, appropriate leadership and a healthy psychosocial work environment are necessary. To make the most out of the available resources and to meet future challenges (among others) in elder care require organizational attention so that leadership and psychosocial work environments continue to develop in both nursing homes and home care. Therefore, structural differences in elder care must be considered to create a better psychosocial work environment for nursing assistants and, in turn, to create higher care satisfaction for those who are receiving elder care in two different social contexts.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2018. , p. 84
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 094
Keywords [en]
Leadership, psychosocial work environment, elder care, nursing homes, home help services
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-42001ISBN: 978-91-85835-93-5 (print)OAI: oai:DiVA.org:hj-42001DiVA, id: diva2:1262213
Public defence
2018-12-14, Forum Humanum, School of Health and Welfare, Jönköping, 10:00 (English)
Opponent
Supervisors
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2018-11-09Bibliographically approved
List of papers
1. Municipal eldercare: Leadership differences in nursing homes and home help services
Open this publication in new window or tab >>Municipal eldercare: Leadership differences in nursing homes and home help services
2017 (English)In: MOJ Gerontology & Geriatrics, E-ISSN 2574-8130, Vol. 1, no 2, p. 30-36Article in journal (Refereed) Published
Abstract [en]

Eldercare organizations have become increasingly multifaceted, and leaders play an important role in such organizations. This study used the developmental leadership questionnaire (DLQ) to compare perceptions of leadership in nursing homes with perceptions of leadership in home help services for older adults. A total of 21 leaders and 95 subordinates responded. Almost all were women; only seven men participated. Both leaders and subordinates perceived more positive leadership styles in nursing homes than in home help services. Leaders self-evaluations showed significant differences in the variables “promoting creativity” (p = 0.021), “management-related competencies” (p = 0.022), “capacity to cope with stress” (p = 0.002), and “results of leadership” (p = 0.034). Evaluations of leaders by subordinates showed significant differences in “not overcontrolling” (p = 0.018). Our findings suggest that the social service should recognize the differences in the way nursing homes and home help services are organized and should recruit leaders with traits and behaviours desirable to each setting.

Place, publisher, year, edition, pages
MedCrave Group, 2017
Keywords
Leadership, subordinates, eldercare, nursing homes, home help services
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-28109 (URN)10.15406/mojgg.2017.01.00008 (DOI)
Note

Included in these in its submitted manuscript form (licentiate thesis, 2015), and in its accepted form (doctoral thesis, 2018).

Available from: 2015-10-07 Created: 2015-10-07 Last updated: 2018-11-09Bibliographically approved
2. Leadership and the psychosocial work environment in old age care
Open this publication in new window or tab >>Leadership and the psychosocial work environment in old age care
2016 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 11, no 1, p. 44-54Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

To study leadership factors and their associations with psychosocial work environmental among nursing assistants who are engaged in old age care and to analyse (i) differences in the assessment of leadership factors and the assessment of psychosocial work environmental in nursing homes and home help services and (ii) the association between the psychosocial work environment and factors that are related to leadership in nursing homes and home help services.

Background

Leadership factors are an important element of the psychosocial work environment in old age care. The physical distance between leaders and nursing assistants is larger in home help services than in nursing homes. Therefore, it is important to study leadership separately in nursing homes and home help services.

Design

Assessments from 844 nursing assistants in nursing homes and 288 in home help services (45 nursing homes and 21 home help service units) were analysed.

Methods

The data were analysed using linear regression. Age, gender, number of staff at the unit, number of years at the current working unit and educational level were controlled in Model 1. Summarised indexes that were based on all independent variables except the main independent variable were additionally controlled in Model 2.

Results

Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. Empowering leadership, support from superiors, the primacy of human resources and control over decisions were associated with higher assessments on all the variables that were related to the psychosocial work environment in both the nursing homes and home help services.

Conclusions

Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better prerequisites for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services.

Implications for practice

Due to the differences in organisational settings, it is important to consider the differences in prerequisites in conducting leadership. To influence nursing assistants' performance and to increase quality in old age care in the long term, appropriate leadership is necessary.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
leadership; nursing assistants; old age care; staff; supervision; work environment
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-28110 (URN)10.1111/opn.12088 (DOI)000373104200006 ()26073426 (PubMedID)2-s2.0-84958672579 (Scopus ID)
Available from: 2015-10-07 Created: 2015-10-07 Last updated: 2018-11-09Bibliographically approved
3. The association between psychosocial work environment and satisfaction with old age care among care recipients
Open this publication in new window or tab >>The association between psychosocial work environment and satisfaction with old age care among care recipients
2018 (English)In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523Article in journal (Refereed) Epub ahead of print
Abstract [en]

This study examines the association between nursing assistants’ perceptions of their psychosocial work environment and satisfaction among older people receiving care in nursing homes and home care. Cross-sectional surveys were conducted among people receiving care (N = 1,535) and nursing assistants (N = 1,132) in 45 nursing homes and 21 home care units within municipal old-age care. Better psychosocial work environment was related to higher satisfaction in old-age care among the recipients. Significant and stronger associations were more common in nursing homes than in home care. Perception of mastery and positive challenges at work were associated with higher recipient satisfaction both in home care and in nursing homes: social climate, perception of group work, perception of mastery, and positive challenges at work only in nursing homes. Findings suggest that recipient satisfaction may be increased by improving the psychosocial work environment for nursing assistants, both in nursing homes and in home care. 

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
home care, nursing assistants, nursing homes, old-age care, psychosocial work environment, satisfaction with care, staff
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-40926 (URN)10.1177/0733464818782153 (DOI)XYZ ()2-s2.0-85048887876 (Scopus ID)
Available from: 2018-07-03 Created: 2018-07-03 Last updated: 2018-11-09
4. The impact of leadership and Psychosocial Work Environment on Recipient Satisfaction in Old-Age Care
Open this publication in new window or tab >>The impact of leadership and Psychosocial Work Environment on Recipient Satisfaction in Old-Age Care
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background and Objective:

This study examines the association between nursing assistants’ assessment of leadership, their psychosocial work environment and satisfaction among older people receiving care in nursing homes and home care.

Research Design and Methods:

Cross-sectional surveys were conducted with nursing assistants (N = 1132) and people receiving care (N = 1535) in 45 nursing homes and 21 home care units within municipal old-age care.

Results:

Direct leadership was associated with the psychosocial work environment in nursing homes and home care. Furthermore, better leadership was related to higher satisfaction among nursing assistants and older people in nursing homes. Thus, indirect leadership had no effect on recipients’ satisfaction in either nursing homes or home care. The path analysis showed an indirect effect between leadership factors and recipient satisfaction.

Discussion:

The findings suggest that the psychosocial work environment of nursing assistants and recipient satisfaction innursing homes can be increased by improving leadership.

Keywords
satisfaction with care, nursing assistants, nursing homes, home care
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-41998 (URN)
Note

Submitted to journal

Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2018-11-09
5. Changes in perceived psychosocial work environment in old age carefrom 2007 to 2015
Open this publication in new window or tab >>Changes in perceived psychosocial work environment in old age carefrom 2007 to 2015
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This study examines changes in nursing assistants’ perceived psychosocial work environment 2007-2015 and whether there are differences between nursing homes and home care. Repeated cross-sectional surveys were conducted (summed sample N = 9400) in nursing homes and home care units. Mixed linear models with random intercept, slope and variance were used. Nursing assistants in nursing homes assess their psychosocial work environment better than nursing assistants in home care do. When analysing linear trends for the entire time period (2007-2015), we found a decline in control at work (p < .001) in both nursing homes and home care and positive trends for stimulus from work itself (nursing homes, p < .001 and home care, p = .004). This indicates that nursing assistants perceived decreasing control of their work situation and increasing stimulus from work itself over the period 2007-2015. The results indicated shifting trends when the municipality introduced different reforms, such as the act of a system of choice in the public sector and the implementation of home health care. These findings suggest that it is important for old-age care organisations to consider long-term consequences for nursing assistants’ psychosocial work environment when implementing new reforms and organizational changes.

Keywords
Elder care, nursing homes, home care, psychosocial work environment
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-42000 (URN)
Note

Submitted to journal

Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2018-11-09

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