Burnout among Health Care Professionals during COVID-19.

The present study examined organizational, situational (i.e., COVID-19-related), and psychological factors associated with burnout during the COVID-19 pandemic among 268 health care professionals in Norway. A total burnout score based on the Burnout Assessment Tool (BAT), the four core BAT subscales (i.e., Exhaustion, Mental Distance, Cognitive Impairment, and Emotional Impairment), and the COVID-19 Burnout Scale served as the dependent variable. Among the results, organizational factors such as work-home conflict, workload, and role conflict were positively related to burnout. Although autonomy and colleague support were negatively related to burnout, support from leaders was positively related to it, which might suggest a suppressive effect. Organizational factors explained most of the variance in general burnout (i.e., BAT Total), whereas situational (i.e., COVID-19-related) factors (e.g., involvement with COVID-19, fear of COVID-19, and COVID-19-induced stress) seemed to better explain COVID-19 burnout. COVID-19-oriented actions were related only to Mental Distance. Psychological factors such as meaning were negatively related to BAT Total, Exhaustion, and Mental Distance, whereas a breach of the psychological contract was related to all subscales. Such results suggest that organizational and situational factors contribute differently to general and COVID-19 burnout and that administering pandemic-specific assessment tools can clarify how the pandemic has affected mental health.

To Change or Not to Change: A Study of Workplace Change during the COVID-19 Pandemic.

After the outbreak of the COVID-19 pandemic, many employees were suddenly required to work more from home. Previous literature on working from home may not be applicable to this mandatory and overall change. In this study, we drew on the Job Demands-Resources (JD-R) model to explore the relationships between job demands (workload and work-home conflict) as well as resources (support from leaders, coworkers, and the family) and wellbeing (burnout and work engagement) in employees who still went to the workplace (no-change group) and employees who transitioned into working from home (change group) during the COVID-19 pandemic. Data were analyzed with multivariate structural equation modeling. The results indicate that work-home conflict was detrimental for employee wellbeing in both groups. Interestingly, the workload seems to contribute to work engagement for employees who worked from home. Regarding the resources, the three different sources of social support, leaders, coworkers, and family, were all related to employee wellbeing, but in different ways. It seemed that family support was most important for employees' wellbeing in the change group. This study presents implications for the wellbeing of employees in both the change and no-change group during the COVID-19 pandemic, emphasizing the importance of family-friendly policies.

"We All Held Our Own": Job Demands and Resources at Individual, Leader, Group, and Organizational Levels During COVID-19 Outbreak in Health Care. A Multi-Source Qualitative Study.

BACKGROUND: Interventions tackling COVID-19 impact on health care workers' mental health would benefit from being informed by validated and integrated assessment frameworks. This study aimed to explore the fitness of integrating the Job Demands-Resources (JD-R) model and the Individual-Group-Leader-Organization (IGLO) framework to investigate the pandemic's impact on health care workers' mental health. METHODS: Qualitative data were collected via 21 semi-structured interviews with senior and middle managers and four focus groups with employees (doctors, nurses, health care assistants) from three areas (Department of Emergency, Department of Medicine, Research Institute of Neuroscience) of a large health care institution facing the first wave of COVID-19. NVivo deductive content analysis of text data was performed. FINDINGS: Several COVID-19-related job demands and resources were found at IGLO levels. Individual-level demands included emotional load, while resources included resilience and motivation. Group-level demands included social distancing, while resources included team support and cohesion. Leader-level demands included managers' workload, while resources included leader support. Organizational-level demands included work reorganization, while resources included mental health initiatives. CONCLUSIONS/APPLICATION TO PRACTICE: Integrating JD-R and IGLO proved feasible, as job demands and resources could be categorized according to the individual, group, leader, and organization framework. The findings expand previous studies by filling the lack of knowledge on how job demands and resources might unfold at different workplace levels during a pandemic. Results provide unit-level evidence for designing and implementing multilevel interventions to manage health care workers' mental health during COVID-19 and future pandemics. Our findings offer occupational health practitioners a suitable approach to perform workplace mental health assessment activities.

Within- and between-person changes in work practice and experiences due to COVID-19: Lessons learned from employees working from home, hybrid working, and working at the office.

Introduction: In response to the requirement of keeping social distance during the COVID-19 outbreak a lot of employees needed to change from a regular office to a home-office at short notice. The aim of the present study is to explore these employees' experiences and evaluate changes in their work situation during the pandemic. Method: A mixed-method design was used with panel data collected twice in an insurance company in Norway. The first dataset was collected in December 2020 (Time 1; N = 558), with a follow up in March 2021 (Time 2; N = 601). Results: Our study indicated that employees' main reasons for working from home were to keep social distance, avoid contagion and protect their loved ones. Flexibility, timesaving and more time with family and friends were also motivators. Most employees reported that they had the necessary technical equipment to work from home and wanted more opportunity to use their home office in the future. General Linear Models (GLM) indicated that work-family balance and workload were the same across age, gender, and worksites. Women and employees working from home reported more fear of being infected by COVID-19 at work. Younger employees reported experiencing less social contact with colleagues than normal during the pandemic, compared to the older employees. Overall, employees working at home were more positive toward digital solutions and digital meetings than those at the office. Repeated measures MANOVA showed that the work motivation and digital competence decreased over time for all worksites. Productivity increased for home-office employees but decreased for the hybrid and work-office employees. Discussion: This paper contributes to knowledge of employees' experiences with different worksite solutions, which will be useful for anticipating employees experience in the future with more hybrid work.

Participation in employment and day care for adults with intellectual disabilities: Equal access for all?

BACKGROUND: The employment rate for people with intellectual disabilities is low. This study aims to increase the knowledge about the association between age, gender, diagnosis, functional level, educational level, and daily activities for adults with intellectual disabilities. METHOD: A multinomial logistic analysis was applied to registry data on 12,735 adults with intellectual disabilities from the Norwegian Information System for the Nursing and Care Sector (IPLOS) and Statistics Norway (SSB). RESULTS: Higher likelihood of employment and day care participation were associated with younger age but differed between genders and diagnoses. High functional level and lack of a registered functional level decreased the likelihood for employment. Educational level was not associated with employment. CONCLUSIONS: The systematic differences in employment and day care participation among people with intellectual disabilities indicate that actions are needed to prevent inequalities. Improved individual assessment of personal resources and wishes might promote participation in employment and day care.

Change and stability: Within-person life satisfaction over a 20-year period using data from the HUNT survey.

Background: The aim of the present study was to investigate within-person life satisfaction (LS) dynamics for two age groups, 20-29 and 30-39 years, from 1984 to 1986 and to follow them over a 20-year period. Methods: Data from 1984 to 2008 were extracted from the large, prospective, longitudinal North-Trøndelag Health Study (HUNT), Norway. This paper includes data from more than 14,500 persons. Data were analysed using logistic regression, and LS dynamics were modelled using gender, time and self-rated health. Results: The analyses revealed that about 20% of people in these age groups had a stable level in LS, also known as set point. Long-term LS change, defined as ⩾2 SDs, was reported for 9% and 6% of people in the youngest and oldest age groups, respectively. A large proportion of more than 70% of people had fluctuations in their LS over a 20-year period. A significant decrease in within-person LS was seen for the age groups from 1984-86 to 1995-97 where a significant increase appeared from 1995-97 to 2006-08. For the initial 20-29 age group, the odds of having a higher score increased by 34%, and for the initial 30-39 age group, the within-person LS increase was 81%. Self-rated health was the most crucial variable influencing within-person LS. Conclusions: These findings suggest that a significant proportion of the responders had a long-term within-person LS change over the 20-year period.

Age groups changes in self-rated health: A prospective longitudinal study over a 20-year period using Health Survey of North Trøndelag data.

Background: The aim of the study was to investigate changes in self-rated health (SRH) between different age groups and sexes over a 20-year period. Methods: Data were retrieved from the large longitudinal Health Survey of North Trøndelag, Norway, which includes data collected from more than 190,000 participants aged 20-70+ years between the years 1984 and 2008. Data were analysed using logistic regression and adjusted for sex. Results: From 1984 to 2008, the odds of scoring higher on SRH decreased by 46% in the youngest age group (20-29 years) and increased by approximately 35% in the middle-aged and older age groups (40-70+ years). When considering sex differences, women in most age groups scored lower than the men on their SRH. Conclusions: Our finding suggest a trending shift in SRH, with a reduction in the youngest age group (20-29 years) and an increase in the middle-aged and older age groups (40-70+ years). Despite the sex differences being small, our data indicate that in most age groups, women tend to score lower than men on their SRH. Future studies should focus on these trends to understand better the mechanisms underlying these changes in SRH and to follow future trends to see if the trend is reinforced or diminished.

Antecedents and Consequences of Perceived Inclusion in Academia.

A diversified workforce is a current trend in organizations today. The present paper illuminates the antecedents, consequences, and potential gender differences of a rather new concept salient to contemporary work life, namely, perceived inclusion. The hypothesized relationships were tested in a sample of academics and faculty staff at different higher education institutions in Norway (n = 12,170). Structural equation modeling analyses supported hypotheses that empowering leadership and social support from the leader (but not the fairness) are positively related to perceived inclusion. Further, perceived inclusion is positively related to organizational commitment, work engagement, and work-home facilitation and negatively related to work-home conflict. By utilizing multigroup analyses, we found support for the hypothesis that compared to women, men perceive their organization as more inclusive. However, in contrast to what was hypothesized, the proposed relationships in the model were stronger for men than women, suggesting that not only do men perceive their work environment as more inclusive, but their perception of inclusion is also more strongly related to beneficial outcomes for the organization. These results provide insight into the antecedents of and strategies for fostering an inclusive work environment, as a response to leveraging and integrating diversity in everyday work life.

H-WORK Project: Multilevel Interventions to Promote Mental Health in SMEs and Public Workplaces.

The paper describes the study design, research questions and methods of a large, international intervention project aimed at improving employee mental health and well-being in SMEs and public organisations. The study is innovative in multiple ways. First, it goes beyond the current debate on whether individual- or organisational-level interventions are most effective in improving employee health and well-being and tests the cumulative effects of multilevel interventions, that is, interventions addressing individual, group, leader and organisational levels. Second, it tailors its interventions to address the aftermaths of the Covid-19 pandemic and develop suitable multilevel interventions for dealing with new ways of working. Third, it uses realist evaluation to explore and identify the working ingredients of and the conditions required for each level of intervention, and their outcomes. Finally, an economic evaluation will assess both the cost-effectiveness analysis and the affordability of the interventions from the employer perspective. The study integrates the training transfer and the organisational process evaluation literature to develop toolkits helping end-users to promote mental health and well-being in the workplace.

Healthy Universities. The development and implementation of a holistic health promotion intervention programme especially adapted for staff working in the higher educational sector: the ARK study.

Underpinned by the Healthy Universities settings concept, this paper presents a holistic intervention approach, called ARK, to improve the health and well-being of academic staff. ARK (a Norwegian acronym for work environment and climate study) has been conducted in 18 universities and university colleges in Norway. The survey has collected information on employees' perceptions of the psychosocial work environment, well-being, and health from over 15,000 respondents. Further, it has provided valuable information and experiences on organizational development processes on how to successfully implement a health-promoting intervention programme. The aim of this paper is to present the ARK project and provide suggestions on how to conduct a health-promoting intervention programme in a university setting based on the experience and knowledge acquired from ARK. This understanding can inform and inspire the planning of future Health Promoting University initiatives to meet the distinctive needs of its employees.

Affective organizational commitment among nursing home employees: A longitudinal study on the influence of a health-promoting work environment.

AIM: To investigate whether affective organizational commitment (AOC) among nursing home employees is enhanced by a health-promoting work environment, conceptualized as high levels of job resources, work-related sense of coherence (work-SOC) and low levels of job demands. DESIGN: This study used a longitudinal design. Survey data were collected with a 1-year interval between 2015/2016-2016/2017 among nursing home employees in Norway. METHODS: Structural equation modelling was used to analyse the longitudinal data (N = 166) and cross-sectional data from the first time point (N = 558). RESULTS: The results supported that work-SOC was strongly and positively related to AOC. Job resources and job demands were positively and negatively related, respectively, to work-SOC but were not related to future AOC. The indirect effects of autonomy and supervisor support on AOC, via work-SOC, were significant. The indirect effects regarding social community at work, emotional demands and role conflict were unclear.

The Line Manager's Role in Implementing Successful Organizational Interventions.

The aim of the paper is to discuss the role of the line manager in implementing to plan, implement and evaluate successful organizational interventions using our experiences from the ARK-program. Earlier literature has shown that line managers have a major influence on an intervention's outcomes (Nielsen, 2017; Saksvik, Nytrø, Dahl-Jørgensen, & Mikkelsen, 2002), however, there is a lack of knowledge about the managements' role throughout the entire intervention process and how line managers are influenced by the context at different levels. We therefore discuss the line managers' role within the five phase cycle of an organizational intervention, including preparation, screening, action planning, implementation and evaluation. We also introduce a more in-depth understanding of the context by using of the IGLO-model (Individual, Group, Leadership and Organizational level). Based on our knowledge and experience from the ARK-program we make some recommendations for (a) what the line managers need throughout the five phases in order to contribute to a successful intervention, and (b) on what the line manager has to provide in order to develop and implement a successful intervention process.

The line manager's role in implementing successful organizational interventions

The aim of the paper is to discuss the role of the line manager in implementing to plan, implement and evaluate successful organizational interventions using our experiences from the ARK-program. Earlier literature has shown that line managers have a major influence on an intervention's outcomes (Nielsen, 2017; Saksvik, Nytrø, Dahl-Jørgensen, & Mikkelsen, 2002), however, there is a lack of knowledge about the managements' role throughout the entire intervention process and how line managers are influenced by the context at different levels. We therefore discuss the line managers' role within the five phase cycle of an organizational intervention, including preparation, screening, action planning, implementation and evaluation. We also introduce a more in-depth understanding of the context by using of the IGLO-model (Individual, Group, Leadership and Organizational level). Based on our knowledge and experience from the ARK-program we make some recommendations for (a) what the line managers need throughout the five phases in order to contribute to a successful intervention, and (b) on what the line manager has to provide in order to develop and implement a successful intervention process

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Validation of the Norwegian version of the work-related sense of coherence scale.

AIM: The aim of this study was to investigate the psychometric properties of the Norwegian version of the work-related sense of coherence scale, which measures the perceived comprehensibility, manageability, and meaningfulness of an individual's current work situation. METHODS: Factorial validity, convergent and discriminant validity of the factors, as well as scale reliability were tested with confirmatory factor analyses among two samples of employees in higher education institutions ( N = 6951) and nursing homes ( N = 558). Factorial invariance across occupational groups was also investigated. RESULTS: A modified three-factor structure was shown to be valid and reliable in both samples and invariant across occupational groups. However, problems were detected regarding the discriminant validity between the factors comprehensibility and manageability. CONCLUSIONS: The Norwegian version of the work-related sense of coherence scale seems to have good properties. Further development is needed to better distinguish between the comprehensibility and manageability dimensions.

Has life satisfaction in Norway increased over a 20-year period? Exploring age and gender differences in a prospective longitudinal study, HUNT.

AIM: The aim of the present study was to investigate the change in overall life satisfaction for different age groups and between genders over a 20-year period. METHODS: Data from 1984 to 2008 were extracted from a large prospective longitudinal health study of Nord-Trøndelag (HUNT), Norway. The study included more than 176,000 participants ranging from 20 to 70+ years of age. Data were analysed using logistic regression and adjusted for gender. RESULTS: The analyses revealed an increase in life satisfaction for all age groups from 1984-1986 (HUNT 1) to 1995-1997 (HUNT 2), with the highest levels being reached at 2006-2008 (HUNT 3). For all age groups, the data showed an increase of about 20% for the period from 1984-1986 (HUNT 1) to 1995-1997 (HUNT 2). From 1995-1997 (HUNT 2) to 2006-2008 (HUNT 3), the increase in overall life satisfaction was 16% for the younger age groups, and about 32% for the older age groups (40-69 and 70+ years). Women's scores for overall life satisfaction were higher for nearly all age groups when compared to men using HUNT 3 as a reference. CONCLUSIONS: These findings suggest an increase in life satisfaction for all age groups from 1984 to 2008, especially for the older age group (40-69 and 70+ years). The data indicate that women score higher on life satisfaction for most age groups as compared to men.

Occupational differences in work engagement: A longitudinal study among eight occupational groups in Norway.

The aim of the present study was to explore occupational differences in the experience of engagement both with regard to differences in the level of work engagement as well as in the predicting value of different antecedent variables. Multigroup latent mean analysis was performed on eight different occupational groups in Norway (lawyers, physicians, nurses, teachers, church ministers, bus drivers, and people working in advertising and information technology; N = 3,475). Tests for factorial invariance supported the use of the Oldenburg Burnout Inventory scale across occupational groups and that the latent means were comparable across the groups. Results indicated significant occupational differences in the experience of vigor and dedication. The lawyers reported the most vigor and the church ministers the most dedication. Least vigor was reported among the teachers and the advertising group reported to be least dedicated. Cross-lagged multigroup structural equation modeling (SEM) analysis suggested there are different processes behind the development of engagement across occupations. Visualization of how some occupations cluster or differ from each other is important as it might engender theory building and further hypotheses testing.

The presentation and preliminary validation of KIWEST using a large sample of Norwegian university staff.

AIMS: The aim of the present paper is to present and validate a Knowledge-Intensive Work Environment Survey Target (KIWEST), a questionnaire developed for assessing the psychosocial factors among people in knowledge-intensive work environments. METHODS: The construct validity and reliability of the measurement model where tested on a representative sample of 3066 academic and administrative staff working at one of the largest universities in Norway. RESULTS: Confirmatory factor analysis provided initial support for the convergent validity and internal consistency of the 30 construct KIWEST measurement model. However, discriminant validity tests indicated that some of the constructs might overlap to some degree. CONCLUSION: Overall, the KIWEST measure showed promising psychometric properties as a psychosocial work environment measure.

A longitudinal study of the relationship between work engagement and symptoms of anxiety and depression.

This longitudinal study examined the dynamic relationship between work engagement (vigour and dedication) and symptoms of anxiety and depression. A sample of 3475 respondents from eight different occupational groups (lawyers, physicians, nurses, teachers, church ministers, bus drivers, people working in advertising and people working in information technology) in Norway supplied data at two points in time with a 2-year time interval. The advantages of longitudinal design were utilized, including testing of reversed causation and controlling for unmeasured third variables. In general, the results showed that the hypothesized normal causal relationship was superior to a reversed causation model. In other words, this study supported the assumption that work engagement is more likely to be the antecedent for symptoms of depression and anxiety than the outcome. In particular, the vigour facet of work engagement provides lower levels of depression and anxiety 2 years later. However, additional analyses modelling unmeasured third variables indicate that unknown third variables may have created some spurious effects on the pattern of the observed relationship. Implications of the findings are discussed in the paper.

The effect of self-transcendence on depression in cognitively intact nursing home patients.

Aims. This study's aim was to test the effects of self-transcendence on depression among cognitively intact nursing home patients. Background. Depression is considered the most frequent mental disorder among the elderly population. Specifically, the depression rate among nursing home patients is three to four times higher than that among community-dwelling elderly. Therefore, finding new and alternative ways to prevent and decrease depression is of great importance for nursing home patients' well-being. Self-transcendence is related to spiritual as well as nonspiritual factors, and it is described as a correlate and resource for well-being among vulnerable populations and at the end of life. Methods. A two-factor construct of the self-transcendence scale (interpersonal and intrapersonal) and the hospital anxiety and depression scale (HADS) was applied. A sample of 202 cognitively intact nursing home patients in central Norway was selected to respond to the questionnaires in 2008/2009. Results. A hypothesized SEM model demonstrated significant direct relationships and total effects of self-transcendence on depression. Conclusion and Implication for Practice. Facilitating patients' self-transcendence, both interpersonally and intrapersonally, might decrease depression among cognitively intact nursing home patients.

Exploring within- and between-gender differences in burnout: 8 different occupational groups.

OBJECTIVES: The aim of this study was to examine gender differences in burnout within and between occupations using latent mean analysis. METHODS: Burnout was measured using the Oldenburg Burnout Inventory (OLBI), designed to assess the two sub-dimension exhaustion and disengagement. Men and women from eight different occupational groups in Norway were investigated: lawyers, physicians, nurses, teachers, church ministers, bus drivers and people working in advertising and information technology (n = 4,965). The average age was 42 years (SD 10.8), and 50.5% of the respondents were female. Within- and between-gender differences were examined by multi-group latent mean analysis by means of LISREL. RESULTS: Significant latent mean differences in the two dimensions of burnout between men and women were demonstrated. In general, the analyses indicate that overall, women report more exhaustion, but not more disengagement, than men. However, separate analyses indicate that the gender differences vary across occupational groups, especially for the disengagement dimension. Within-gender analyses suggest an approximately similar burnout profile across occupational groups for men and women. CONCLUSIONS: Despite gender equality in society in general, and inconclusive findings in previous studies on gender differences in burnout, women in this study seem to experience slightly higher burnout levels than men. Occupational differences found in the burnout profiles indicate that some professions may be more prone to burnout than others. For the occupational groups most at risk, more research is needed to disclose potential organizational factors that may make these workers more prone to burnout than others.