The problem and management of sickness absence in the NHS: considerations for nurse managers

AIM: This paper examines the topic of sickness absence management in the context of the healthcare sector. BACKGROUND: National Health Service (NHS) employee absenteeism is an expensive and difficult problem. Nurse managers need to assess the extent and characteristics of absenteeism, be aware of their organization's sickness policies, evaluate the effectiveness of these policies and contribute to the development of related initiatives to ensure prudent management of sickness absence. METHOD: A literature review has been undertaken, providing a broad conceptual context by which the problem of sickness absence in the NHS can be examined. The focus of this paper is to examine the accumulation of research based knowledge to provide a healthcare perspective on the problem of sickness absence management. CONCLUSION: Sickness absence management within the NHS is challenging but provides opportunities to improve the working lives of NHS employees. Sickness absence cannot be eradicated but it can be reduced by a selection of measures that reflect the uniqueness of the NHS. The many and diverse causes of sickness absence need acknowledgement, when devising strategies that can effectively provide solutions to the problems of sickness absence.     

Locus of control and regional differences in sickness absence in Sweden

Purpose. The aim of this study was to investigate if there are differences in locus of control (LOC), at a societal level, between two residential areas in Sweden with substantial differences in sickness absence.

Method. A postal questionnaire was sent to 1500 randomly selected men and women aged 20 - 64 years. Five hundred questionnaires were sent to people living in Stromsund (a sparsely populated municipality in northern Sweden with high rates of sickness absence) and 1000 questionnaires to people in the Swedish capital of Stockholm, which has a low rate of sickness absence.

Results and conclusion. A comparison of LOC in the two study areas supported our hypothesis to a certain extent, external locus being more prominent in Stromsund. When physical and mental health and income were considered, however, the differences disappeared. Consequently, this study did not support the opinion that differences in sickness absence can be explained by LOC at a societal level.     

Locus of control and regional differences in sickness absence in Sweden

Purpose.?The aim of this study was to investigate if there are differences in locus of control (LOC), at a societal level, between two residential areas in Sweden with substantial differences in sickness absence.

Method.?A postal questionnaire was sent to 1500 randomly selected men and women aged 20?–?64 years. Five hundred questionnaires were sent to people living in Stromsund (a sparsely populated municipality in northern Sweden with high rates of sickness absence) and 1000 questionnaires to people in the Swedish capital of Stockholm, which has a low rate of sickness absence.

Results and conclusion.?A comparison of LOC in the two study areas supported our hypothesis to a certain extent, external locus being more prominent in Stromsund. When physical and mental health and income were considered, however, the differences disappeared. Consequently, this study did not support the opinion that differences in sickness absence can be explained by LOC at a societal level.     

Stability of return to work after a coordinated and tailored intervention for sickness absence compensation beneficiaries with mental health problems: results of a two-year follow-up study

Abstract

Purpose: Mental health problems (MHPs) are increasingly common as reasons for long-term sickness absence. However, the knowledge of how to promote a stable return to work (RTW) after sickness absence due to MHPs is limited. The purpose of this study was to assess the effects of a multidisciplinary, coordinated and tailored RTW-intervention in terms of stability of RTW, cumulative sickness absence and labour market status after 2 years among sickness absence compensation beneficiaries with MHPs. Methods: In a quasi-randomised, controlled trial, we followed recipients of the intervention (n?=?88) and of conventional case management (n?=?80) for 2 years to compare their risk of recurrent sickness absence and unemployment after RTW, their cumulative sickness absence and their labour market status after 2 years. Results: We found no statistically significant intervention effect in terms of the risk of recurrent sickness absence or unemployment. Intervention recipients had more cumulated sickness absence in year one (mean difference?=?58 days; p?<?0.01) and year two (mean difference?=?36 days; p?=?0.03), and fewer were self-supported at the end of follow-up (52% versus 69%; p?=?0.02). Conclusion: The intervention showed no benefits in terms of improved stability of RTW, reduced sickness absence or improved labour market status after 2 years when compared to conventional case management.

• Implications for Rehabilitation

• Evidence for effective return-to-work (RTW) interventions for people with mental health problems is limited, as most research to date has been done in the context of musculoskeletal disorders.

• A complex, multidisciplinary intervention, detached from the workplace, does not appear to improve the stability of RTW and may actually lead to more sickness absence days and less self-support when compared to conventional case management of sickness absence beneficiaries in Denmark.

• A stronger focus on cooperation with social insurance officers and employers may produce better results.

     

Patterns of sickness absence a decade after pain-related multidisciplinary rehabilitation

Multidisciplinary programmes using a vocational approach can enhance work return in chronic pain patients, but little is known about the long-term effects of rehabilitation. The current study examined the patterns of sickness absence 10 years after participation in 3 treatment groups (physiotherapy, cognitive behavioural therapy, and vocational multidisciplinary rehabilitation) in comparison to a control group receiving treatment-as-usual. Cost-effectiveness was also assessed. Two hundred fourteen patients participated in a randomized controlled trial and were followed-up via register data 10 years after the interventions. On average, persons in multidisciplinary rehabilitation had 42.98 fewer days on sickness absence per year compared to those treated-as-usual (95% confidence interval −82.45 to −3.52, P = 0.03). The corresponding reduction of sickness absence after physiotherapy and cognitive behavioural therapy was not significantly different from the control group. The effect of rehabilitation seems to be more pronounced for disability pension than for sick leave. The economic analyses showed substantial cost savings for individuals in the multidisciplinary group compared to the control group.     

Diabetes and pregnancy: women's opinions about the care provided during the childbearing year

Background:  The extended programmes for pregnant women with diabetes, needed to improve pregnancy outcome, might negatively influence the experience of expecting a baby.
Aim:  To investigate opinions about care during pregnancy, childbirth and the postnatal period among women with diabetes mellitus (DM) and gestational DM (GDM).
Method:  A four-part questionnaire was constructed, covering the childbearing year, with a focus on treatment and information. A total of 156 women were asked to participate (53 DM, 103 GDM), three refused. The questionnaire was anonymous.
Results:  The reply frequency was 94%. Of all answers, 95% fell in neutral-satisfied range (Lickert scale 2–5). Three answering patterns deviated positively (care on Specialist Antenatal Clinic, accessibility, and participation–responsibility–respect). Four patterns deviated negatively (information flow, preparation, postpartum care and postpartum check-up). Increased supervision caused problems with time for the family and at work. Comments showed focus on diabetes, forcing the healthy pregnancy aspects into the background. The answers concerning treatment indicated satisfaction (4 + 5 Lickert scale). Women with GDM felt badly prepared before the glucose tolerance test. It was doubtful whether they had been able to make an informed choice about participating. Lack of knowledge among staff was pointed out. Need for more written material was expressed.
Conclusion:  Satisfaction with care was shown. A discussion about the implication of informed choice with both staff and mothers are needed. Sharper implementation of the diabetes-care-chain was also an area for improvement.     

Influences on women's participation in cardiac rehabilitation.

The purpose of this study was to compare the cardiac rehabilitation referral and enrollment rates of men and women eligible for cardiac rehabilitation. A review of 202 hospital charts found that men and women were equally likely to be referred for cardiac rehabilitation, but women were significantly less likely to enroll (p < 0.05). Ten women who did not enroll and 20 women who did enroll were interviewed to determine factors that influenced their participation in the program. Major motives for enrolling included a desire to improve one's health and the strength of the physician's recommendation. Barriers to enrollment included concern for family members, transportation problems, physical limitations, and expense. Surprisingly, all of the women who did not enroll showed an interest when contacted after they were discharged from the hospital. Based on the findings of this study, it was recommended that cardiac rehabilitation staff telephone women after they are discharged to answer questions, clarify misconceptions, and encourage enrollment in a cardiac rehabilitation program.     

An act of courage: women's decision-making processes regarding outpatient cardiac rehabilitation attendance.

The purpose of this qualitative study was to describe the factors that affect women's attendance and adherence to a cardiac rehabilitation (CR) program after a myocardial infarction (MI). We used in-depth interviews and a health survey form to collect data. The purposive sample consisted of 40 women who had experienced a first MI within the previous 6 weeks to 12 months. Of those 40, 18 women were not offered the program, 8 declined it, and 14 attended. Using content analysis and constant comparison, we identified three distinct phases: "initial decision," "CR attendance," and "reevaluation." Four data clusters positively influenced the continuation of CR attendance: "Psychological Appraisal," "Program Components," "Staff Behaviors," and "Outcomes." When women encountered a fifth cluster--"Barriers"--they entered the reevaluation phase. Results of this study support specific interventions for each phase.     

One-year prospective study on the effect of workplace bullying on long-term sickness absence

ortega a ., christensen k.b. , hogh a. , rugulies r. & borg v. (2011) Journal of Nursing Management 19, 752–759
One-year prospective study on the effect of workplace bullying on long-term sickness absence Aims To examine the effect of workplace bullying on long-term sickness absence using a prospective design. Background Although bullying has been identified as a serious problem in the health care sector, little attention has been given to the possible effect of workplace bullying on long-term sickness absence and its implications. Methods The sample consisted of 9949 employees (78.1% response rate) working in the elderly-care sector in 36 Danish municipalities. Long-term sickness absence was measured by linking a survey on work and health to the national register on social transfer payments. Results Among the 1171 employees that were bullied at work in the past 12 months, 1.8% were frequently bullied and 7.3% were occasionally bullied. The risk of long-term sickness absence was higher for those frequently bullied even after adjusting for psychosocial work characteristics [rate ratio (RR) = 1.92, confidence interval (CI): 1.29–2.84; P < 0.05]. Conclusion This is the first prospective study that explored the effect of both frequent and occasional bullying on long-term sickness absence among health care employees. The effect of frequent bullying on long-term sickness absence was independent of the psychosocial work characteristics. Implications for Nursing Management Workplace bullying might impact negatively the quality of care and patients safety.     

Personal perceptions and women's participation in cardiac rehabilitation.

The purpose of this study was to determine whether there were differences in personal perceptions between women who participated in cardiac rehabilitation (CR) and women who did not. This cross-sectional study used a convenience sample of 370 female patients who had been treated and discharged between April 1, 1995, and September 30, 1995. Three standardized scales, a self-report instrument, and medical records reviews were used to collect data at five hospitals and four CR centers in three midsized northeastern Ohio cities. Differences in personal perception and demographic variables between participants and nonparticipants were examined. Education, history of coronary heart disease (CHD), and specific cardiac diagnoses showed statistically significant differences between the groups. Logistic regression tested the model for participation. No variable or group of variables was found to predict CR participation in this sample of women. All cardiac patients need information about CR. Patients with less education, a history of CHD, and a diagnosis of stable angina need special instructions and closer follow-up.     

Nursing handover within mental health rehabilitation: an exploratory study of practice and perception

Nursing handover is an established practice that involves an interchange of information between nurses to inform of the condition of patients. It is essential to nursing practice in terms of continuity and quality of patient care. However, there is a lack of agreement about the quality, content, and process of handover and, in particular, a lack of information specific to mental health contexts. This paper reports the results of exploratory research of the practice and beliefs about verbal nursing handover within an inpatient mental health rehabilitation setting. Qualitative data were obtained from audiotaped handovers and interviews with nurses and analysed using content analysis. Handovers were found to lack structure and content, be retrospective, problem-focused and inconsistent. The findings were fairly consistent with the literature and would likely be applicable across nursing settings; however, the need to appraise nursing handover in unique contexts was also revealed. The study raised questions about how nursing handover reflects the goals and philosophies of mental health rehabilitation and whether nursing handover is an activity fully integrated with the focus of mental health rehabilitation.