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Facilitators for and barriers to nurses’ work-related health: a qualitative study
Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, PO Box 408, Skövde, 541 28, Sweden.ORCID iD: 0000-0002-6596-5837
School of Public Health, Patan Academy of Health Sciences, GPO Box 26500, Lalitpur, Nepal.
Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, PO Box 408, Skövde, 541 28, Sweden.
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Behavioural Sciences, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, Oslo, 0130, Norway.ORCID iD: 0000-0002-7669-4702
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2022 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, no 1, article id 218Article in journal (Refereed) Published
Abstract [en]

Background: Work-related health problems, such as work stress, fatigue, and burnout constitute a global challenge within the nursing profession. Work-related health among nurses is not yet a prioritized phenomenon in Nepal. Health-promoting approaches to maintaining and sustaining nurses’ health are therefore essential. The aim of this study was to explore and thereby gain a deeper understanding of how nurses in Nepal’s hospitals experience their everyday work, with a focus on promoting and sustaining their work-related health.

Methods: A qualitative design with semi-structured individual interviews were used. Nineteen registered nurses working at hospitals in Kathmandu Valley, Nepal, were individually interviewed between October 6 and December 5, 2018. Transcribed interviews were analyzed through thematic analysis.

Results: Four main themes with belonging eight subthemes were constructed from the analysis: (1) “Sense of meaningfulness and belongingness in work culture” with subthemes; “Open environment” and “Sharing attitude and cooperating for the entire team” (2) “Support and rewards from the management team” with subthemes; “Lacking managerial support” and “Fair evaluation and job promotion opportunities”(3) “Workload and protection against work-related hazards” with subthemes; “Stressful and multitasking in workload” and “Lacking equipment for own health and caring”, and (4) “Motivation through opportunities and activities” with subthemes; “Employment benefits that motivate work”, and “Activities outside of work needed to recover”. These main themes and subthemes described nurses’ facilitators for and barriers to their work environment and health.

Conclusion: Our study highlighted nurses’ experiences with facilitators and barriers to their work-related health. Nurses’ work-related health was positively affected by support from colleagues, managers, and the organization. Conversely, less support from managers, lack of equipment, and unfair judgment were barriers to nurses’ work-related health. This study adds new knowledge about nurses’ work-related health from the context of Nepal. Hospital organizations and nursing managers in similar cultural and healthcare settings can apply the results of our study to develop strategies to promote and sustain nurses’ health and prevent work-related illness.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022. Vol. 21, no 1, article id 218
Keywords [en]
article, care behavior, employment, genetic transcription, health promotion, hospital organization, human, interview, manager, motivation, Nepal, nurse, nurse manager, physiological stress, qualitative research, registered nurse, reward, teamwork, thematic analysis, work environment, workload, Job resources, Managerial support, Nurses, Stress, Work-related health
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-58166DOI: 10.1186/s12912-022-01003-zISI: 000836600400001PubMedID: 35931988Scopus ID: 2-s2.0-85135440648Local ID: HOA;;825044OAI: oai:DiVA.org:hj-58166DiVA, id: diva2:1687242
Funder
Wilhelm och Martina Lundgrens Vetenskapsfond, 2017–1824Swedish Research Council, 2016–05682
Note

Included in doctoral thesis in manuscript form.

Available from: 2022-08-15 Created: 2022-08-15 Last updated: 2023-03-20Bibliographically approved
In thesis
1. A health-promotive approach to maintain and sustain health in women-dominated work in Nepal and Sweden
Open this publication in new window or tab >>A health-promotive approach to maintain and sustain health in women-dominated work in Nepal and Sweden
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The characteristics of women-dominated work differ in Nepal compared to Sweden. Women in Nepal perform household and other low-income work, including nursing, which is a women-dominated occupation in both Nepal and Sweden. Work-related adverse health outcomes, such as burnout, fatigue, depression, sleep disturbances, and long-term sickness absence, are evident in women-dominated work, especially within nursing. These challenges are accompanied by an increasing elderly population and a shortage of nursing personnel. Good health and well-being for all, improving working conditions and working environment, and providing adequate health and safety at work are the targets of sustainable development goals. Health-promotive actions and interventions are needed to maintain and sustain health in women-dominated work.

Aims: The overall aim of this thesis was to identify means for promoting and sustaining health in women-dominated work in Nepal and Sweden through the evaluation and exploration of sense of coherence (SOC), work-related health, job demands, job resources, and health outcomes.

Methods: This thesis includes five individual papers. Paper I is a community-based intervention study with a quantitative design conducted in Nepal. The participants were 857 women before and 1268 women after health education intervention in Nepal, who responded to a translated version of the SOC-13 questionnaire in Nepali. Papers II and III have a qualitative design and are based on 19 individual interviews with nurses in Nepal. Paper IV is also a qualitative study, based on 13 individual interviews with midwives and nurses in Sweden. Paper V is derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH). Data were collected in 2016–2019 for all papers. The quantitative studies were analyzed through descriptive statistics, chi-squared tests, one-way analyses of variance (ANOVAs), multivariable one-way ANOVAs, and logistic regression analyses. The qualitative studies were based on individual interviews, and the data were analyzed through qualitative content analysis and thematic analysis.

Results: Women in semi-urban Nepal exhibited total SOC mean values between 51.1 and 57.4, which are comparable to India within a similar context. Qualitative validation of the SOC-13 questionnaire in Nepali was found to begeneral and not specific, and some translations were confusing. The SOC-13 items needed to undergo further editing in translation to increase their comprehensions. Nurses in Nepal and nurses and midwives in Sweden described their work experience as meaningful, and several experiences were partially similar; their work and health were reported to be strengthened through collegial support, teamwork, and opportunities for skills and competence development. Shift work, lack of rewards and appreciation from managers, low staff-patient ratios, and high workload affected their work-related health negatively. In particular, nurses in Nepal experienced a lack of a safe physical work environment and insufficient managerial support. Results from SLOSH-data showed that the nursing professionals’ job demands were associated with lower self-rated health, higher burnout, and higher sickness absence. Job resources were associated with higher self-rated health and lower burnout.

Conclusion: This thesis shows that the SOC-13 questionnaire is useful and qualitatively validated for future use in the Nepalese context, to explore individuals’ overall life orientation and abilities to cope with various life events. Health education can be useful in strengthening SOC among women. To maintain, promote, and sustain health in women-dominated work, a health-promotive approach should be fostered. Nursing professionals’ health can be strengthened and sustained through the development of a positive work environment through good collegial, organizational, and managerial support, offering skills and competence development opportunities, and creating a safe physical and psychosocial work environment. Increasing job resources and minimizing job demands are important to increase positive health outcomes and decrease adverse health outcomes. Nursing professionals in Nepal and Sweden can also adopt strategies that support recovery and stress-management at work.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2022. p. 146
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 115
Keywords
experiences, health promotion, nursing professionals, resources, salutogenesis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-56296 (URN)978-91-88669-14-8 (ISBN)
Public defence
2022-06-01, G110, University of Skövde, Skövde, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2022-04-27 Created: 2022-04-27 Last updated: 2023-03-20Bibliographically approved

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Thapa, Dip RajAreskoug Josefsson, Kristina

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