Health,work, and personal-related predictors of time to return to work among employees with mental health problems

Purpose: To identify health-, personal- and work-related factors predictive of return to work (RTW) in employees sick-listed due to common mental health problems, such as, stress, depression, burnout, and anxiety. Methods: We distributed a baseline questionnaire to employees applying for sickness absence benefits at a large Danish welfare Department (n?=?721). A total of 298 employees returned the questionnaire containing information on possible predictors of RTW. We followed up all baseline responders for a maximum of one year in a national registry of social transfer payments, including sickness absence benefits. Results: At baseline, about 9% of respondents had quit their job, 10% were dismissed and the remaining 82% were still working for the same employer. The mean time to RTW, measured from the first day of absence, was 25 weeks (median?=?21) and at the end of follow-up (52 weeks) 85% had returned to work. In the fitted Cox model we found that fulfilling the DSM-IV criteria for depression predicted a longer time to RTW (HR: 0.61, CI: 0.45–0.84), whereas a better self-rated health predicted a shorter time to RTW (HR: 1.18, CI: 1.03–1.34). Employees working in the municipal (HR: 0.62, CI: 0.41–0.94) and private sector (HR: 0.65, CI: 0.44–0.96) returned to work slower compared to employees working in the governmental sector. Gender, education, cohabitation, size of workplace, low-back and upper-neck pain and employment at baseline did not predict RTW. Conclusion: Our results indicate that time to RTW is determined by both health- and work-related factors.

Implications for Rehabilitation

• Common mental health problems are one of the leading causes for sickness absence and work disability

• Return to work after sickness absence is not solely determined by improvements in health but is also affect by individual and work related factors

• This study showed that self-rated health, occupational sector and depression are predictors of time to return to work in employees with mental health problems

     

Determinants of return to work among Nigerian stroke survivors

Purpose: Employment, an important aspect of life, could be adversely affected by a disabling condition like stroke. This study explores the frequency and determinants of return to work (RTW) among Nigerian stroke survivors. Method: One-hundred and one stroke patients attending Physiotherapy clinics at seven teaching and specialist hospital centers in north-eastern Nigeria participated in the study. Socio-demographic, clinical and RTW data were obtained from participants while the modified Rankin Scale was used to assess functional ability. Chi-square statistics and multivariable logistic regression analysis was used to identify the determinants of RTW among the participants. Results: About half of the participants (55%) had returned to work. Absence of disability [Odds Ratio (OR) = 57.7; 95% CI = 12.0–276.8) and mild disability (OR = 15.1; 95% CI = 3.9–58.3) were the significant determinants of RTW, while post-stroke duration of a year or less was associated with lower chance of returning to work (OR = 0.2; 95% CI = 0.0–0.8). Conclusions: The prominence of functional independence among the determinants of RTW implies that rehabilitation efforts and support programmes to optimize functional ability, especially within the first year after stroke, will greatly enhance RTW among Nigerian stroke survivors.

Implications for Rehabilitation

• Functional outcome influenced vocational outcome, hence the need for rehabilitation efforts at improving functional status of stroke survivors to encourage return to work (RTW).

• The low rate of RTW within the first year after stroke may be addressed by the establishment of specilized sub-acute and long-term rehabilitation centers in Nigeria instead of depending only on existing inadequate outpatient rehabilitation practices

     

Improved work ability and return to work following vocational multidisciplinary rehabilitation of subjects on long-term sick leave.

OBJECTIVE: To evaluate a vocational multidisciplinary rehabilitation programme for patients on long-term sick leave with respect to their work ability and return to work. METHODS: A multidisciplinary rehabilitation programme was administered to an intervention group of 183 patients on long-term sick leave (mean 12.2 months). Effects of the treatment were compared with a control group (n = 96) recruited from the national sickness insurance record of patients on sick leave of 6-12 months duration (mean 11.5 months). Perceived work ability, return to work, background factors and psychosocial aspects of work were assessed on the basis of questionnaires at baseline and after 4 months. RESULTS: Perceived work ability of the intervention group improved significantly after 4 months compared with the control group (p < 0.01). In the intervention group, 80% had returned to work compared with 66% in the control group (p = 0.06). Return to work after 4 months was predicted by good work ability at baseline, improved work motivation, improved work ability at follow-up and increased rumours of change in the workplace (R2 26.1-38.6%, p < 0.05). CONCLUSION: This multidisciplinary rehabilitation programme significantly improved perceived work ability compared with treatment as usual.     

Work-related stress, education and work ability among hospital nurses

Title. Work‐related stress, education and work ability among hospital nurses. Aim. This paper is a report of a study conducted to determine which occupational stressors are present in nurses’ working environment; to describe and compare occupational stress between two educational groups of nurses; to estimate which stressors and to what extent predict nurses’ work ability; and to determine if educational level predicts nurses’ work ability. Background. Nurses’ occupational stress adversely affects their health and nursing quality. Higher educational level has been shown to have positive effects on the preservation of good work ability. Method. A cross‐sectional study was conducted in 2006–2007. Questionnaires were distributed to a convenience sample of 1392 (59%) nurses employed at four university hospitals in Croatia (n = 2364). The response rate was 78% (n = 1086). Data were collected using the Occupational Stress Assessment Questionnaire and Work Ability Index Questionnaire. Findings. We identified six major groups of occupational stressors: ‘Organization of work and financial issues’, ‘public criticism’, ‘hazards at workplace’, ‘interpersonal conflicts at workplace’, ‘shift work’ and ‘professional and intellectual demands’. Nurses with secondary school qualifications perceived Hazards at workplace and Shift work as statistically significantly more stressful than nurses a with college degree. Predictors statistically significantly related with low work ability were: Organization of work and financial issues (odds ratio = 1·69, 95% confidence interval 1·22–2·36), lower educational level (odds ratio = 1·69, 95% confidence interval 1·22–2·36) and older age (odds ratio = 1·07, 95% confidence interval 1·05–1·09). Conclusion. Hospital managers should develop strategies to address and improve the quality of working conditions for nurses in Croatian hospitals. Providing educational and career prospects can contribute to decreasing nurses’ occupational stress levels, thus maintaining their work ability.     

Relationships between stressors, work supports, and burnout among cancer nurses

This pilot study investigated the relationships between stressors, work supports, and burnout among cancer nurses. One hundred and one registered nurses, employed at a major specialist oncology, metropolitan Australian hospital, completed self-report questionnaires measuring these constructs and provided responses to open-ended questions. The 50 listed stressors were experienced as sources of stress by more than 50% of the sample; most work support came from peers, rather than supervisor and organizational supports; and the overall level of burnout for the sample was moderate to low. Significant positive correlations were found between Stressors and the Emotional Exhaustion and Depersonalization subscales of the Maslach Burnout Inventory and a significant weak positive correlation between Peer Support and Personal Accomplishment (intensity). Findings are discussed in relation to developing strategies for reducing stress and burnout among cancer nurses, and directions for further study are suggested.     

Relationships among patient satisfaction,intent to return,and intent to recommend services provided by an academic nursing center

Patient satisfaction is an indicator and component of high quality care and service and the viability of academic nursing centers is dependent on patients' return visits and new patients' visits. The major purpose of this study was to determine patients' satisfaction with the quality of health care services provided by an academic nursing center. A secondary purpose was to determine the relationships among patient satisfaction, intent to return, and intent to recommend services. The study consisted of a convenience sample of 107 adult patients who responded to an investigator generated patient satisfaction survey. Findings indicated that 94 (87.8%) of the patients were satisfied. Stepwise regression analysis identified treatment with respect, the rating of care received, and the helpfulness of the person at the front desk as the strongest predictors of patient satisfaction. Correlation analysis revealed that patient satisfaction is highly correlated with intent to return and intent to recommend services (p < .01).     

Relationships among bilingualism, critical thinking ability, and critical thinking disposition.

Evidence exists supporting relationships between bilingualism and many cognitive factors. Research, however, has not been conducted to specifically examine the relationships among bilingualism, critical thinking ability, and critical thinking disposition of baccalaureate nursing students. This cross-sectional study used a pooled, within-bilingual, correlational design to examine such relationships. Specific research questions posed were: (1) is there a statistically significant curvilinear relationship between bilingualism and critical thinking ability, (2) is there a statistically significant curvilinear relationship between bilingualism and critical thinking disposition, and (3) is there a statistically significant relationship between critical thinking disposition and critical thinking ability? A convenience sample of nursing students (N = 111) was administered a French language Cloze Test (C-Test), an English language C-Test, as well as the California Critical Thinking Skills Test, and the California Critical Thinking Disposition Inventory. Multiple regression analysis was used to test the hypotheses. Findings failed to provide sufficient evidence to support the existence of a relationship between either bilingualism and critical thinking ability, or between critical thinking disposition and critical thinking ability. However, there was sufficient evidence to support the existence of a curvilinear relationship between bilingualism and critical thinking disposition. Implications for nursing education are presented.     

Interrelationships among workload,illness severity,and function on return to work following acute respiratory distress syndrome

BackgroundInability to return to work (RTW) is common after acute respiratory distress syndrome (ARDS).ObjectivesThe aim of this study is to examine interrelationships among pre-ARDS workload, illness severity, and post-ARDS cognitive, psychological, interpersonal, and physical function with RTW at 6 and 12 months after ARDS.MethodsWe conducted a secondary analysis using the US multicentre ARDS Network Long-Term Outcomes Study. The US Occupational Information Network was used to determine pre-ARDS workload. The Mini-Mental State Examination and SF-36 were used to measure four domains of post-ARDS function. Analyses used structural equation modeling and mediation analyses.ResultsAmong 329 previously employed ARDS survivors, 6- and 12-month RTW rates were 52% and 56%, respectively. Illness severity (standardised coefficients range: ?0.51 to ?0.54, p < 0.001) had a negative effect on RTW at 6 months, whereas function at 6 months (psychological [0.42, p < 0.001], interpersonal [0.40, p < 0.001], and physical [0.43, p < 0.001]) had a positive effect. Working at 6 months (0.79 to 0.72, P < 0.001) had a positive effect on RTW at 12 months, whereas illness severity (?0.32 to ?0.33, p = 0.001) and post-ARDS function (psychological [6 months: 0.44, p < 0.001; 12 months: 0.33, p = 0.002], interpersonal [0.44, p < 0.001; 0.22, p = 0.03], and physical abilities [0.47, p < 0.001; 0.33, p = 0.007]) only had an indirect effect on RTW at 12 months mediated through work at 6 months.ConclusionsRTW at 12 months was associated with patients' illness severity; post-ARDS cognitive, psychological, interpersonal, and physical function; and working at 6 months. Among these factors, working at 6 months and function may be modifiable mediators of 12-month post-ARDS RTW. Improving ARDS survivors' RTW may include optimisation of workload after RTW, along with interventions across the healthcare spectrum to improve patients’ physical, psychological, and interpersonal function.     

Stroke. Risks, recognition, and return to work.

1. The two major classifications of stroke are ischemic and hemorrhagic. Ischemic strokes account for 75% of all strokes and result from the complete occlusion of an artery. Hemorrhagic strokes, often caused by aneurysm or hypertension, are caused by the rupture of a cerebral blood vessel and bleeding into the surrounding tissue. 2. The signs and symptoms of stroke may include unilateral weakness or paralysis, a sagging of one side of the face, double or blurred vision, vertigo, numbness or tingling, and language disturbances. 3. Management of ischemic stroke may include thrombolytic agents (e.g., heparin, warfarin) if the individual is treated within 6 hours after the onset of symptoms. Diagnostic tests may include, computed tomography scan, transesophageal echocardiagraphy, Doppler ultrasonography, and electrocordiography. 4. Occupational health nurses can be actively involved in helping workers modify their risks for stroke, developing and implementing an action plan if an individual is experiencing a stroke, and facilitating the individual's reentry into the worksite after rehabilitation is completed.     

Workers' disability and return to work.

A severe injury on the job often results in a medical recovery period requiring either a temporary or long-term absence from work. Rehabilitation interventions emphasizing return to work may facilitate recovery and prevent workers from becoming unemployed. A review of the current literature suggests a direct relationship between workers' demographic and disability-related characteristics, early referral to rehabilitation and successful return to work. This article describes findings from a research study designed to investigate factors associated with the return to work of injured workers. Data from 200 workers' compensation cases from a large automobile manufacturing employer in the state of Michigan were analyzed in terms of workers' demographics and other characteristics including type and severity of injury, cause of injury, type of medical intervention received, disability status, worker's job experience and wages before injury; disability costs to employer; the provision of vocational rehabilitation services; and return-to-work outcomes. Variables found to be significantly related to return to work outcomes included workers' age, education, wages before injury, job seniority and severity of the injury. Workers who successfully returned to work had higher seniority in their jobs, more education and were paid higher wages. Workers whose injuries were more severe and longer lasting, were less likely to return to work. Back impairments appeared to be a particular risk factor for return to work regardless of vocational rehabilitation intervention.     

Motivation and return to work among the long-term sicklisted: an action theory perspective

Purpose : The purpose of this study is to enlighten motivation and return to work among the long-term sicklisted.

Method : Data are from a mail questionnaire answered by 185 people living in the Stockholm metropolitan area in Sweden. All subjects were on long-term sick leave owing to back or neck symptoms, they were 18 - 55 years of age and had an employer. A part of the questionnaire was based on an action theory perspective emphasising the respondent's own view of his or her present and future situation. People answered structured questions about what kind of work they wanted, if they thought they could get such a work and if they thought they could manage this type of work. All three aspects are of importance in the study of motivation. A follow-up of the employment status of the respondents was made about two years after the questionnaire had been answered. The relationships between their plans and employment status were studied.

Results : The results show that our questions had good predictive validity, i.e. there were clear correlations between the answers and employment status two years later. It was shown that wanting to return to work is connected to one's view of own possibilities. What a person wants is not an isolated opinion, but clearly connected with the other aspects, particularly own competence ('can manage').

Conclusion : It is concluded that the action theory approach could be developed into an instrument for 'action analysis' that could be used in work with vocational rehabilitation. Such a development is now under way.     

Motivation and return to work among the long-term sicklisted: an action theory perspective

Purpose : The purpose of this study is to enlighten motivation and return to work among the long-term sicklisted. Method : Data are from a mail questionnaire answered by 185 people living in the Stockholm metropolitan area in Sweden. All subjects were on long-term sick leave owing to back or neck symptoms, they were 18 - 55 years of age and had an employer. A part of the questionnaire was based on an action theory perspective emphasising the respondent's own view of his or her present and future situation. People answered structured questions about what kind of work they wanted, if they thought they could get such a work and if they thought they could manage this type of work. All three aspects are of importance in the study of motivation. A follow-up of the employment status of the respondents was made about two years after the questionnaire had been answered. The relationships between their plans and employment status were studied. Results : The results show that our questions had good predictive validity, i.e. there were clear correlations between the answers and employment status two years later. It was shown that wanting to return to work is connected to one's view of own possibilities. What a person wants is not an isolated opinion, but clearly connected with the other aspects, particularly own competence ('can manage'). Conclusion : It is concluded that the action theory approach could be developed into an instrument for 'action analysis' that could be used in work with vocational rehabilitation. Such a development is now under way.     

Relationships among demands at work,aggression, and verbal abuse among registered nurses in South Korea

BackgroundIn order to improve organizational culture and job outcomes, it is important to characterize and better understand the relationship between aggression and verbal abuse among nurses.PurposeTo examine the relationships among demands at work, aggression, and verbal abuse among nurses.MethodsA cross-sectional study was conducted using survey data from three tertiary hospitals located in South Korea. Sixteen nursing units were selected and 378 nurses’ data were used as the final sample. The relationships were examined by multiple linear or logistic regression analyses.FindingsMore than 70% of the nurses had experienced at least 1 type of verbal abuse. Higher physical aggression and hostility were significantly related to greater verbal abuse experience.ConclusionTo prevent the vicious cycle of victims becoming perpetrators, it is necessary to develop and implement concrete strategies to manage verbal abuse and aggression among nurse colleagues.     

Evaluating patients for return to work

The family physician is often instrumental in the process of returning a patient to the workplace after injury or illness. Initially, the physician must gain an understanding of the job's demands through detailed discussions with the patient, the patient's work supervisor or the occupational medicine staff at the patient's place of employment. Other helpful sources of information include job demand analysis evaluations and the Dictionary of Occupational Titles. With an adequate knowledge of job requirements and patient limitations, the physician should document specific workplace restrictions, ensuring a safe and progressive reentry to work. Occupational rehabilitation programs such as work hardening may be prescribed, if necessary. If the physician is unsure of the patient's status, a functional capacity evaluation should be considered. The family physician should also be familiar with the Americans with Disabilities Act as it applies to the patient's "fitness" to perform the "essential tasks" of the patient's job.