The relationships of job and family demands and job and family resources with family caregivers' strain.

BACKGROUND: Because of an expected increase in the number of family caregivers, there is a growing public and scientific interest in family caregiving and more specifically in the combination of family care with paid employment. It is important to gain insight in the family caregivers' strain and determining factors in the job and family domain. AIM: The aim of the study was to examine the associations of job and family demands and job and family resources with indicators of caregivers' psychological strain, that is caregiver burden, work-related emotional exhaustion and general ill mental health. In our research, we focused on individuals who combine paid employment with family caregiving. METHODS: A cross-sectional design was used. The study sample was derived in 2011 from a Dutch financial organisation and a healthcare organisation. A digital fully structured questionnaire was used. The sample consisted of 187 employees who identified themselves as family caregivers. Descriptive statistics and hierarchical linear regression analysis were performed. RESULTS: Job demands (i.e. workload, work-family conflict) and family demands (i.e. family care hours and family-work conflict) were significantly positively associated with all three domain-specific indicators of strain. The resources of work-family and family-work enrichment and autonomy did not contribute to less experienced strain. More supervisor and colleague support was associated with lower ill mental health. CONCLUSION: Our study showed that job demands (workload, work-family conflict) and family demands (family care hours, family-work conflict) were clearly associated with caregiver strain, while associations for job and family resources were not evident. It remains necessary to pay attention to the demanding aspects of dual roles of family caregivers but also to investigate the resources they have available at work as well as in their home situation and explore their potential reducing effect on family caregivers' strain.

A cross-sectional study on experiences of young adult carers compared to young adult noncarers: parentification, coping and resilience.

BACKGROUND: Most young carer studies on parentification, resilience and coping concentrated on child carers up to age 18 years, whereas the group of young adult caregivers (18-24 years) has been neglected. In our study, we focused on these young adult caregivers, who are in a life phase in which young people usually are distancing themselves from their families and are striving for autonomy and freedom. AIM: To explore young adult carers' perceptions of parentification, resilience and coping compared to young adult noncarers. DESIGN: Cross-sectional. METHODS: In 2014/2015, data were collected on 297 healthcare students from a school for vocational education and a university in the Netherlands. A fully structured questionnaire was used. Young adult carers were compared with young adult noncarers on parentification, resilience and coping. RESULTS: Fifty-six students identified themselves as a carer: 40 vocational education students and 16 university students. Carers scored significantly higher than noncarers on three out of six parentification dimensions. No differences were found for resilience and problem-focused coping behaviour, whereas results for emotion-focused coping demonstrated a higher score for the carers compared to the noncarers. CONCLUSION: Although it is important to take care of the needs of all young carers, special attention should be given to those who are at the start of their adult lives, undergoing extensive changes and taking major decisions on study and career issues. Home-care professionals and school counsellors should be able to recognise this group and their needs and activate support from specialised services and significant others.

Double-duty caregivers: healthcare professionals juggling employment and informal caregiving. A survey on personal health and work experiences.

AIMS: This study compared the work-related experiences and personal health status of double-duty caregivers with those of caregivers who do not provide informal care to a family member or close friend in need. BACKGROUND: The interest in providing informal care alongside employment is growing. However, little attention has been paid to the dual role of the healthcare professional who also has caregiving responsibilities for a needy person in his/her private situation. It is important to study the negative and positive consequences of this combination of professional and family care giving. DESIGN: A cross-sectional study. METHODS: In 2011, we distributed a digital questionnaire to employees with a professional care function working at a healthcare organization in the Netherlands. Descriptive statistics, analyses of covariance and tests of linearity were performed. RESULTS: Analyses of variance demonstrated that as professional healthcare workers provide more hours of informal care in their private lives, their mental and physical health significantly worsens, while their need for recovery increases. Also, statistical significant increases were seen for emotional exhaustion, presenteeism and negative experiences with Work-Home and Home-Work Interferences. Remarkably, positive Home-Work Interference increased significantly with increasing hours of informal care. Double-duty caregivers appeared to be equally motivated and satisfied with their work as their co-workers. No differences were seen with respect to absenteeism. CONCLUSION: Double-duty caregivers prove to be employees who are at risk of developing symptoms of overload. This finding calls for special attention, with long-term solutions at both legislative and organizational level.

Age-differences in work motivation and job satisfaction. The influence of age on the relationships between work characteristics and workers' outcomes.

This study investigated the influence of age on the relationship between work characteristics and workers' work motivation and job satisfaction. In total, 1036 workers of a Dutch division of a multinational organization participated. Data were collected by a digital questionnaire. Two interaction terms in the regression on work motivation were significant. The first interaction showed that the positive correlation between Motivating Potential Score (MPS) and motivation was much stronger for older than for younger employees. So, to remain motivated, older employees seem more in need of intrinsic challenging and fulfilling jobs. The second significant interaction indicated that the positive association between career opportunities and motivation was much stronger for younger employees than for older employees. This means that, especially, younger workers' motivation increases as they are offered more career opportunities. Careful career mentoring by the supervisor as part of an aging policy can contribute to the maintenance of workers of any age.

Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands.

AIM: This paper is a report of a study conducted to determine if satisfaction with irregular working hours that are a form of shiftwork operates as a mediator between work and home characteristics and health problems. BACKGROUND: Shiftwork contributes to health problems, decreased well-being and poorer health habits. It also affects employees' decisions to leave the healthcare sector. Although many nurses voluntarily work shifts, there have been few studies of their satisfaction with irregular working hours when these are a form of shiftwork. METHODS: A survey was carried out with 144 nurses working in three nursing homes and one care home in the Netherlands. Questionnaires were distributed in 2003 to 233 nurses who worked shifts (response rate 60%). The questionnaire contained items on work and home characteristics, satisfaction with irregular working hours that are a form of shiftwork and health. A new scale to measure satisfaction with irregular working hours was constructed. RESULTS: All work characteristics, but no home characteristics, were associated with satisfaction with irregular working hours. The work characteristics 'job demands' and the home characteristics 'autonomy at home' and 'home demands' were associated with health. Satisfaction with irregular working hours did not mediate between work/home characteristics and health. Those reporting more social support, lower job demands and more job autonomy were more satisfied with their irregular working times that were a form of shiftwork. CONCLUSIONS: Satisfaction with irregular working hours is a useful construct that requires further longitudinal study. The results also underline the importance of considering home characteristics when predicting health outcomes.

Conditions for successfully implementing resident-oriented care in nursing homes.

This study reports an investigation of the conditions for a successful introduction of a resident-oriented care model on six somatic and psychogeriatric intervention wards in three Dutch nursing homes. This study aims to answer the following research question: 'What are the conditions for successfully implementing resident-oriented care?' To answer the research question, the organisational change process was monitored by using the '7-S' model of Peters and Waterman as a diagnostic framework. Based on this model, the following change characteristics were studied: structure, strategy, systems, staff, skills, style and shared values. Our study involved a one group pretest/post-test design. To measure the conditions for change, we operationalised the factors of the 7-S model serving as a diagnostic framework and studied their presence and nature on the intervention wards. For this purpose qualitative interviews were held with the change agents of the nursing homes and the wards' supervisors. To determine the degree of 'success' of the implementation, we measured the extent to which resident-oriented care was implemented. For this purpose a quantitative questionnaire was filled in by the nurses of the intervention wards. By relating the extent to which resident-oriented care was implemented to the differences in change conditions, we were able to distinguish the 'most' from the 'least' successful intervention ward and so, pointing out the conditions contributing to a successful implementation of resident-oriented care. The results showed that, in contrast to the least successful intervention ward, the most successful intervention ward was characterised by success conditions related to the 7-S model factors strategy, systems, staff and skills. The factor structure did not contribute to the success of the implementation. Success conditions appeared to be related to the ward level and not to the organisational or project level. Especially the supervisors' role appeared to be crucial for a successful implementation.

Determinants of early retirement intentions among Belgian nurses.

AIM: This paper is a report of a study to gain insight into older nurses' retirement intentions and to establish factors determining early retirement intention in these individuals. BACKGROUND: In many developed countries, the working population is ageing. This will lead to a structural labour shortage in the near future. In nursing, this is already taking place. To retain nurses in employment, information on the determinants of their early retirement intentions are imperative. METHOD: A cross-sectional study was carried out in 2005 in one Belgian hospital. Data were collected by questionnaire with 100 nurses aged 45 or older. The response rate was 69.9%. FINDINGS: No fewer than 77% of the nurses wanted to stop working before the age of 65 years. The following individual, work-related, and organizational factors contributed to older nurses' intention to retire early: perceived health, marital status, gender, opportunities for change and development, workload, and negative stereotyping of older employees. CONCLUSION: Our findings offer insight regarding the influencing factors of early retirement intentions in nurses. This information may be useful to human resource managers and may enable them to successfully prevent early retirement in nurses. More research on this topic is needed as this will enable the development, implementation and evaluation of well-founded measures for retaining older nurses in the workplace.

The effects of integrated care on quality of work in nursing homes: a quasi-experiment.

BACKGROUND: In nursing homes there is a gradual move from traditional care to integrated care. Integrated care means a demand-oriented, small-scale, co-operated and coordinated provision of services by different caregivers. This integration has direct effect on the work of these separate disciplines. With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved. OBJECTIVES: The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers (work content, communication and co-operation and worker's outcomes). DESIGN: A non-equivalent pre-test/post-test control group design was used in this study. SETTINGS AND PARTICIPANTS: Two nursing homes in the Netherlands participated in the study. One nursing home provided the five experimental nursing wards and the other nursing home provided four control wards. METHOD: Data were selected by means of written questionnaires. RESULTS: The results showed that the intervention appeared to be only successful on the somatic wards. The caregivers of these wards were more able to create a home-like environment for their residents, to use a demand-oriented working method and to integrate the provision of care and services. Regarding the effects of the intervention on quality of work factors, the results included an increase of social support by the supervisor, an increase of the degree of collaboration and a decrease in job demands. No changes were found for the worker's outcomes such as job satisfaction. CONCLUSIONS: The intervention on the psycho-somatic wards was unsuccessful. Although the introduction of integrated care on the somatic wards was successful, the effects on quality of work were limited. Next to quantitative research, more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations, with special attention for specific characteristics of different types of nursing home care (somatic vs. psycho-geriatric).

Differentiated practice, patient-oriented care and quality of work in a hospital in the Netherlands.

This article describes a quantitative study of the relationship between differentiated practice on the one side and patient-oriented care and quality of work on the other. Nursing wards where differentiated practice has been implemented (intervention group) have been compared with wards where differentiated practice has not been implemented (reference group). The research variables with regard to differentiated practice, patient-oriented care and quality of work have been measured by questionnaires. Subjects were 68 nurses and six supervisors from six nursing wards from one hospital. The results show that the extent to which differentiated practice had been implemented varied between the wards. With regard to patient-oriented care differences have been found between the intervention and reference group on the variables patient assignment and use of the nursing process, but not on the variables of tasks and communication. Concerning quality of work, differences have been found on: social support from the supervisor, social-emotional leadership and health complaints. Rank order correlations between differentiated practice and patient-oriented care and between differentiated practice and quality of work were not significant. Practical implications with regard to the use of differentiated practice and implications for further research are discussed.

Resident-oriented care in nursing homes: effects on nurses.

BACKGROUND: In a resident-oriented care model the assignment of patients to primary nurses takes place. These primary nurses are responsible for the total nursing care of their patients and make use of the nursing process. According to job demand-control models, these enlarged and enriched jobs can be described in terms of autonomy, job demands and social support, and the presence of these work characteristics has a positive influence on workers' psychological and behavioural outcomes. AIMS: This paper reports a study to investigate the extent to which the various features of resident-oriented care were implemented and its effects nurses' on work characteristics and on psychological and behavioural outcomes in three Dutch nursing homes. METHODS: In a quasi-experimental design, experimental and control groups were followed over 22 months, using a pretest and two post-tests with questionnaires, interviews and qualitative observations. RESULTS: The quantitative data showed significant increases in resident assignment, the two variables measuring the nursing process and, in the psycho-geriatric experimental group, on resident-oriented tasks. The qualitative data showed that a partly task-oriented division of labour was still used and that the planned delegation of coordination tasks to primary nurses was not fully achieved. Effects on work perceptions were limited. After implementation of the new system, the experimental group showed an increase in job autonomy. CONCLUSIONS: The intervention appeared to be only partly successful. Most of the expected results regarding work characteristics and psychological and behavioural outcomes did not materialize. Theoretical and methodological reflections are presented in the light of these findings.

High-dose ketoconazole therapy in prostatic cancer. A pilot study.

There may be contraindications to oestrogen therapy for prostatic carcinoma, and also patient objections to orchidectomy as a form of therapy. Ketoconazole, a systemic antifungal drug, was evaluated in a dosage of 200 mg 8-hourly given orally as an alternative method of lowering serum testosterone levels. Nineteen patients were studied; 1 was withdrawn because of nausea and vomiting. Only 6 patients (33,3%) had serum testosterone levels in the castrate range after 7 days. It seems that higher doses may be needed to keep testosterone levels consistently low.