Values and evaluation in health care.

The purpose of this paper is to broaden the view of evaluation in health care by 'problemizing' the concepts of quality and evaluation and relating them to a more general discussion of values. The discussion of the concept of quality shows that the concept of quality is often vague or contradictory and that the relationship between quality and costs is problematic. The discussion is broadened by studying quality and evaluation from the viewpoint of four categories of values: scientific values, aesthetic values, ethical values and economic values. The authors also show that values, in addition to constituting the basis for evaluation, actually guide the whole process of care. Values are explicit and implicit elements of the care culture and the individual's action system. The authors conclude that the four value categories could be used to study which values actually guide the care process in real situations.

Caring culture. A study of Swedish geriatric nursing personnel utilizing the Nurse Self-Description Form.

This study is part of main investigation entitled 'The Efficiency of Care. The Importance of Work Environment and Climate', the purpose of which is an examination of the relationships between culture, climate and experiences of care providers and patients in different settings. The purpose of the present study was to investigate the perception care personnel had of themselves as reported on the Nurse Self-Description Form (NSFD). Olsson and Gullberg have added two items to the original 19-item form in the Swedish version. The research was conducted in all six wards of a geriatric hospital in Sweden, and the sample consisted of 67 head nurses, registered nurses, practical nurses and nursing assistants. It was assumed that a similar structure of factor dimensions would appear as in previous studies with the NSFD. The resulting three-factor Varimax solution explained 63% of the variation. A different factor content emerged, however, which required factor names to be provisionally renamed Intuitive-Resourceful Nurse, Ambitious-Knowledgeable Nurse, and Reliable-Considerate Nurse.

Physical and psychosocial work environments among Swedish dental hygienists: risk indicators for musculoskeletal complaints.

The study examines individual and occupational factors and physical and psychosocial exposures related to musculoskeletal complaints in dental hygienists. A standardized questionnaire was sent to 471 registered Swedish hygienists; 77.3% (n = 364) responded, which allows for reliable conclusions for Swedish dental hygienists. Musculoskeletal complaints increased significantly in several body parts with age. And in lower right arm and both elbows with profession years. Public dental health service (PDHS) hygienists experienced significantly more complaints, in the lower right arm (fingers, wrist/hand and elbow). Their work was more demanding, and they had less control compared to work in private practice (PP). In a multiple regression analysis, strainful ergonomics, solitary work, patient treatment hours, and working hours were significant predictors that explained 29% of the variance of musculoskeletal complaints in neck, shoulders, and upper back. Solitary work, years in the profession, strainful ergonomics, and PDHS work explained 15% of the variance of musculoskeletal complaints in the lower right arm. So physical environmental factors contribute to musculoskeletal complaints. Using multivariate analysis, the importance of psychosocial factors did not remain as significant predictors. But a high decision latitude at PP seems health promoting. The results are a useful baseline to discuss the physical layout, organization of dental hygienists' work, and its future direction.

Determinants of work satisfaction among Swedish dental hygienists.

This study examines factors that contribute to work satisfaction among Swedish dental hygienists. A questionnaire was used to collect data on health, demographics, work-history, work characteristics, work satisfaction and social support at work. The questionnaire was mailed to 471 hygienists; 77.3% responded. 70% of the hygienists are highly or very satisfied with their work tasks. Active leisure and working in large cities were significantly related to high work satisfaction. The best linear regression model explained 48% of the variance in work satisfaction. Thirty percent of the variance was explained by work tasks perceived to be skills developing. Skills development in the profession appears low (median = 44%). After controlling work factors, work satisfaction increased with growing skills development for all hygienists, even for those less satisfied with their work. The findings suggest that the opportunities for developing professional skills should increase to improve satisfaction among dental hygienists. Measures should also be taken to improve the work climate, work stimulation, and job variation as well as reduce the collegial pressure at work.