Swedish rehabilitation professionals' perspectives on work ability assessments in a changing sickness insurance system

Purpose.?Changes in the Swedish sickness insurance system shifts focus from return-to-work to labour market reintegration. This article analyses Swedish rehabilitation professionals' perspectives on how the changed regulations affect practice, with a special focus on work ability assessments.

Methods.?Two groups of representatives ((n == 15)) from organizations involved in rehabilitation and return-to-work met at seven occations. The groups worked with a tutor with a problem-based approach to discuss how their practice is influenced by the changed regulations. The material was analysed inductively using qualitative content analysis.

Results.?The new regulations require developed cooperation among insurance, health care, employers and occupational health care; however, these demands are not met in practice. In work ability assessments, several flaws regarding competence and cooperation are identified. An increasing number of people previously assessed as work disabled are required to participate in labour market reintegration, which puts demands on professionals to engage in motivational activities, although this is perceived as hopeless due to the group's lack of employability.

Conclusions.?The possibility for employers to sidestep their responsibility has increased with changed regulations. The overall lack of cooperation between relevant actors and the lack of relevant competence undermine the ambitions of activation and reintegration in the reform.     

Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context

Purpose: To study social validity and perceived fairness of a new method for assessing general work ability in a sickness insurance context. Assessments are based on self-reports, combined with examinations by physicians, and, if needed, occupational therapists, physiotherapists and/or psychologists.

Materials and methods: Interviews with 36 insurance officials, 10 physicians, and 36 sick-listed persons, which were analysed through a qualitative content analysis.

Results: Insurance officials and physicians considered the method useful and that it facilitated benefit decisions. The experiences of persons who had undergone the assessment differed, where the dialog with insurance officials seemed to have had an influence on experiences of the assessment and the decisions it led to.

Conclusions: The perceived fairness and social validity of the assessment depended on how it was carried out; organisational conditions and priorities; communication skills; and decision outcomes. Professionals have an important pedagogical task in explaining the purpose and procedure of the assessment in order for the sick-listed to perceive it as fair rather than square, i.e., too standardised and not considering individual conditions. If the assessment could be used also for rehabilitative purposes, it could possibly be perceived as more acceptable also in cases where it leads to denied benefits.

• Implications for rehabilitation

• The perceived fairness of work ability assessments is dependent on procedures for the assessment, communication with the person, and the outcome.

• What is considered fair differs between assessing professionals and persons being assessed.

• Professionals may influence the perceptions of fairness through their way of communication.

• Assessments need to be coupled with rehabilitation measures in order to perceived as relevant and acceptable.

     

Factors contributing to work-ability for injured workers: literature review and comparison with available measures

Purpose.?Despite a range of factors being proposed in research literature to be key to ‘work-ability’, agreed definitions and boundaries of this concept are lacking. This review sought to identify and clarify key factors thought to contribute to individual work-ability, then compare these against existing measures of work-ability for people with injury.

Method.?A literature search was undertaken based on principles of systematic review. MEDLINE, AMED, Scopus and Web of Science databases were searched. All potentially relevant articles were obtained and, if they met inclusion criteria, evaluated for quality. The search was expanded and repeated to identify currently available measures of work-ability for people with injury. These measures were then compared against components from the first search.

Results.?Thirty-four articles were obtained from the first search, and 23 provided information about factors that contribute to work-ability. Six broad categories were identified: physical, psychological, cognitive, social/behavioural, workplace factors, and factors outside the workplace. The follow-up search identified 10 measures. No one measure captured all six identified categories.

Conclusions.?Components contributing to work-ability go beyond the ability to perform particular work tasks. Measures intended to be used to inform vocational rehabilitation arguably need to consider all these factors to maximise likelihood of a sustainable return to work.     

Intercultural communication in health care: challenges and solutions in work rehabilitation practices and training: a comprehensive review

Purpose: The purpose of this comprehensive literature review it to explore cross-cultural issues in occupational rehabilitation and work disability prevention. Method: A literature review on cross-cultural issues was performed in medicine, health sciences, and social sciences databases (PubMed, Ingenta, Canadian Centre for Occupational Health and Safety, Ergonomics Abstract, Google Scholar, OSH Update and the Quebec Workers’ Compensation Board data base). A total of 27 documents published until 2010 in English or French were selected and analyzed. Results: Cross-cultural issues in occupational rehabilitation show that representations of pain, communication and therapist–patient relationship and intercultural competence could be presented as the major topics covered in the selected literature. As for the general topic of immigrant workers and OSH, barriers were identified revealing personal, relational, contextual and structural levels that put immigrant and minority workers in situation of vulnerability (ex. linguistic and cultural barriers, lack of knowledge of the system, precarious work or exposition to higher risk hazards, etc.). Cultural issues in occupational rehabilitation put less attention to work-related contextual factors but emphasized on attitude and pain behaviours, perceptions of illness and appropriate treatment, therapist–patient relationship and cultural competences among OT professionals. Conclusions: The growth of immigration in countries such as Canada poses a real challenge to the delivery of health care and rehabilitation services. Despite growing concerns in providing culturally appropriate heath cares, intervention models, tools and training tools are still lacking in occupational rehabilitation and disability management. Nevertheless, cultural competence seems to be a promising concept to be implemented in work rehabilitation and disability management.

Implications for Rehabilitation

• Cultural differences may result in diverging and conflicting representations of health, illness and therapy, and this may hinder the healing process or even cause its failure.

• Assessing health and illness representations (perception and definition of the problem and its solution) may help clinicians facilitate cross-personal communication and develop therapeutic alliance.

• Cultural competence in health care is multi-faceted (individual, organization, health policies) and is becoming an unavoidable aspect of developing culturally adapted interventions.

     

The satisfaction with the quality of dementia care and the health,burnout and work ability of nurses: A longitudinal analysis of 50 German nursing homes

Background

The increasing prevalence of residents with dementia in Nursing Homes (NH) leads to a demanding work with high physical and psychological workloads. This study focuses on NH nurses and their satisfaction with quality of care for residents with dementia (SQCD) and its impact on nurses' general health, burnout and work ability.

Method

Two-wave (2007/2009) self-report questionnaire data of 305 nurses (RNs and nurses' aides) from 50 German NHs.

Results

58.6% (2007) and 64.9% (2009) of the respondents reported satisfaction with the quality of care of the dementia residents. However, when dissatisfied, this was perceived as substantial work stressor and was adversely associated with nurses' individual resource outcomes. Those nurses who between 2007 and 2009 had become dissatisfied or were dissatisfied at both measurements showed the most adverse scorings for burnout, general health and work ability.

Discussion

The findings imply that in NHs, SQCD may be a relevant work factor with substantial impact on nurses' core resources.     

Development and validation of a prediction model for long-term sickness absence based on occupational health survey variables

Purpose: The purpose of this study is to develop and validate a prediction model for identifying employees at increased risk of long-term sickness absence (LTSA), by using variables commonly measured in occupational health surveys.

Materials and methods: Based on the literature, 15 predictor variables were retrieved from the DAnish National working Environment Survey (DANES) and included in a model predicting incident LTSA (≥4 consecutive weeks) during 1-year follow-up in a sample of 4000 DANES participants. The 15-predictor model was reduced by backward stepwise statistical techniques and then validated in a sample of 2524 DANES participants, not included in the development sample. Identification of employees at increased LTSA risk was investigated by receiver operating characteristic (ROC) analysis; the area-under-the-ROC-curve (AUC) reflected discrimination between employees with and without LTSA during follow-up.

Results: The 15-predictor model was reduced to a 9-predictor model including age, gender, education, self-rated health, mental health, prior LTSA, work ability, emotional job demands, and recognition by the management. Discrimination by the 9-predictor model was significant (AUC = 0.68; 95% CI 0.61–0.76), but not practically useful.

Conclusions: A prediction model based on occupational health survey variables identified employees with an increased LTSA risk, but should be further developed into a practically useful tool to predict the risk of LTSA in the general working population.

• Implications for rehabilitation

• Long-term sickness absence risk predictions would enable healthcare providers to refer high-risk employees to rehabilitation programs aimed at preventing or reducing work disability.

• A prediction model based on health survey variables discriminates between employees at high and low risk of long-term sickness absence, but discrimination was not practically useful.

• Health survey variables provide insufficient information to determine long-term sickness absence risk profiles.

• There is a need for new variables, based on the knowledge and experience of rehabilitation professionals, to improve long-term sickness absence risk profiles.

     

Low-perceived work ability, ageing and intention to leave nursing: a comparison among 10 European countries

AIM: This paper reports a study exploring nurses' perceived work ability and its associations with age and intention to leave nursing in a representative sample of registered nurses in 10 european countries. BACKGROUND: Throughout Europe, there is now a substantial shortage of Registered Nurses and unless steps are taken to reverse this trend, numbers are likely to decline further. A study exploring nurses' perceived work ability will provide baseline evidence, which may lead to improved working conditions and increased nursing retention. METHODS: A cross-sectional study design was employed. Questionnaire data were collected from 25,976 nurses in 10 member states of the European Union between October 2002 and June 2003. The response rate was 52.9% for the total investigation and varied between countries from 32.4% to 76.9%. Perceived work ability was assessed using the Work Ability Index. Intention to leave was measured by asking nurses how often they thought about leaving nursing. Data were examined using analysis of covariance and adjusted logistic regression. RESULTS: In all 10 European countries, scores on the Work Ability Index were significantly lower (P < 0.01) among older nurses (>or=45 years). Work ability varied among countries and differences between younger and older nurses were more pronounced in some countries. In all countries, there was a significant association between low Work Ability Index and intention to leave nursing (odds ratios between 1.98 and 21.46), especially among younger nurses. The association between work ability and intention to leave was most marked for those items on the Work Ability Index which explored subjective rather than objective aspects of work ability. CONCLUSION: Attempts to redress nursing shortages could include institutional policies to sustain work ability through better working conditions, improving quality of the working environment and finding suitable alternative nursing work for those no longer able to cope in their current post. These approaches should include nurses in all age categories.     

Age-dependent relationships between work ability, thinking of quitting the job, and actual leaving among Italian nurses: a longitudinal study

Background

Qualified nurses commonly report several work-related problems, which may threat their health and work ability, and may have an impact upon retention.

Objective

The aim of the present study was to investigate whether perceived work ability is a predictor for different types of thinking of quitting and for actual exit from the workplace.

Design

A prospective study has been performed based on 3329 Italian registered nurses which responded to both measurements of the Nurses’ Early Exit Study. Institutions were selected by means of a stratified sampling procedure. All the 7447 nurses working in that healthcare organizations were recruited for the study. Baseline questionnaire was collected from 5504 nurses. Response rate at follow-up was 63.4%. Two hundred and fifty-five nurses left the job in the course of the investigation.

Methods

Several multiple logistic regression analyses were performed controlling for indicators of work-related well-being, socio-demographic, and labour-market characteristics.

Results

As a whole, our results show that among nurses younger than 45 years work ability is a significant predictor of different types of thinking of quitting, but not of actual exit from the workplace: a lower perceived work ability was associated with a higher desire to undertake further education (OR: 3.05; 95% CI: 1.30-7.18) and/or to change workplace (OR: 4.03; 95% CI: 1.84-8.83) or profession (OR: 6.67; 95% CI: 2.78-15.99). In contrast, among the older nurses (>45), only actual exit was predicted by lower work ability scores (OR: 7.14; 95% CI: 1.15-44.13), along with the perception of a larger availability of free nursing posts in the region (OR: 2.70; 95% CI: 1.13-6.43).

Conclusion

Therefore, we conclude that in the relationship between low perceived work ability and intended or actual exit, a significant part is explained by age itself, but also by the age-related differences in occupational and life opportunities. This contribution concludes with some age-related policies aimed at boosting nurses’ retention.     

Practice development and health care governance: a recipe for modernization

The terms practice development (PD) and health care governance (HG) have become synonymous with quality and modernization. However, limited activity has been devoted to deciphering why this is the case and what the potential benefits of PD and HG are in supporting the National Health Service modernization agenda. The paper attempts to demystify this issue by providing an insight into the drivers for modernization and through outlining the emerging debates associated with how and why PD and HG may provide the recipe for modernization.     

Primary care groups and trusts: a threat or an opportunity for the development of community-based nursing in England

AIMS OF THE STUDY: To examine the role of Primary Care Groups and Trusts (PCG/T) in relation to nurses working in general practice and community health services. BACKGROUND: Over the past two decades there have been rapid changes in the numbers and roles of nurses working in primary care and community based settings. The establishment of Primary Care Groups offers health care professionals, including nurses, the chance to develop local primary care services and to integrate community and primary care nursing. These developments may offer opportunities or pose threats to nursing staff. RESEARCH METHODS: Data are drawn from a longitudinal study of a randomly selected sample of Primary Care Groups in England (n = 72). In a second survey of Groups carried out in autumn/winter 2000, Primary Care Group chairs and chief officers were interviewed by telephone. RESULTS: Response rates were 97% for both chairs and chief officers (69 of each). Chairs indicated that in most areas Primary Care Groups were consulting with local nurses to develop policy. Fifty-seven (85%) reported that investment in nursing staff and nursing services was a high priority in their area. Twenty-eight (41%) indicated that nurse-led services designed to increase patient access had already been established in their area, and 20 (29%) were planning new nurse-led services. Many developments had been initiated by Primary Care Groups. Initiatives to integrate community and general practice based staff were underway in most areas. CONCLUSIONS: Primary Care Groups and Trusts are initiating changes in general practice and community based services which are likely to have long-term and important implications for nurses in terms of their roles, conditions of work and future careers. It is important that nurses are consulted and are involved in developing and implementing policy change.     

Creation and validation of the PERFECT: a critical incident tool for evaluating change in the practices of health professionals

Rationale The critical incident technique provides a means to better understand the reasons behind clinicians' practices and changes in practice. No standardized tool exists to elicit information using this technique. Objectives To create and validate a standardized tool that explores change and reasons for change in professional practice. Method Item generation was based on expert consultation and a review of the clinical practice and knowledge translation literature. The draft tool was pilot‐tested with a convenience sample of 10 rehabilitation clinicians to receive feedback on its content, clarity, optimal cueing, omissions and ease of recall of critical incidents. Results The tool was progressively refined and validated according to feedback from both the clinicians and expert reviewers. The final version of the tool includes 33 questions designed to elicit information on change and reasons for change in four areas: problem identification, assessment, treatment and referral practices. In addition, it elicits information on factors that facilitate or hinder change in practice. Cues are included when necessary to clarify questions and facilitate responses. Regarding ease of recall, all clinicians confirmed that beginning with a 6‐month recall of practice change and working back to 1 year was a facilitator. All clinicians mentioned that the tool encouraged them to reflect about changes they made in their practice or lack thereof. Conclusion The newly created standardized critical incident tool, named the PERFECT (Professional Evaluation & Reflection on Change Tool) provides an opportunity for widespread applicability to explore change, reasons for change, as well as facilitators and barriers to change in the practices of health professionals.