Cold wind of change: Associations between organizational change, turnover intention, overcommitment and quality of care in Spanish and Swedish eldercare organizations.

Aim: To examine the association between organizational change, turnover intentions, overcommitment and perceptions of quality of care among nurses and nursing assistants employed in eldercare organizations. Design: A longitudinal survey (baseline, 12-month follow-up) was used. Methods: A panel sample of 226 eldercare employees in Spain and Sweden responded to survey questions concerning organizational change, turnover intentions, overcommitment and perceptions of quality of care. The data were analysed using structural equational modelling. Results: We found a statistically significant positive relationship between organizational change, employees' turnover intention and overcommitment. We also found a statistically significant negative relationship between organizational change and perceived quality of care.

Cognitive job crafting as mediator between behavioral job crafting and quality of care in residential homes for the elderly.

Extending previous studies on job crafting, the aim of the present study is to analyze the effect of job crafting on quality of care in residential homes for elderly people in two European countries (Spain and Sweden). We hypothesize that cognitive crafting could be a consequence of behavioral crafting and that it will mediate the relationship between behavioral crafting and the perception of quality of care. A correlational design was used, with two-waves approximately 12 months apart (n = 226). Our results indicate that behavioral job crafting at T1 had an effect on cognitive job crafting at T2, relational job crafting at T1 increases quality of care at T2, and the mediation effect of cognitive job crafting. These results indicate that we must differentiate between the two forms of crafting (behavioral and cognitive), not as indicators of the same latent construct, but as aggregates. Additionally, we point out two main implications for managerial practice. First, as relational job crafting has a direct effect on quality of care, it is important to assure an organizational culture oriented towards employees. Secondly, due to the mediation effect of cognitive job crafting, managers should facilitate meaningful work environments. To do so, jobs should be re-designed, increasing skills variety, identity and significance.

Spanish and Swedish eldercare managers' influence on employees.

PURPOSE: Hierarchical and flat organizational types are predominant in Spain and Sweden, respectively. To study how managers' commitment and work overcommitment (WOC) affect employee well-being, and job perception in these different countries can shed insight on how to improve eldercare organization. The purpose of this paper was to study the association between eldercare employee exposure to managers' commitment and WOC, and employee mental well-being and job perception and how these associations differed between Spain and Sweden. DESIGN/METHODOLOGY/APPROACH: A questionnaire with validated questions on commitment, WOC, mental well-being and job perception, operationalized as the perception of quality of care and turnover intent, was sent out to eldercare managers and employees in Spain and Sweden. t-Tests, χ 2 and linear regression were applied to study the associations and differences between the countries. FINDINGS: Interaction analyses revealed that Spanish employees' mental well-being and job perception were influenced by their managers' commitment and WOC in that manager commitment improved and WOC impaired well-being and job perception. However, the Swedish eldercare employees were not influenced by their managers on these parameters. PRACTICAL IMPLICATIONS: The impact of managerial commitment and WOC differed between employees in Spain and Sweden, possibly because the preconditions for leadership varied due to differences in organizational type. ORIGINALITY/VALUE: This study compares the managers' impact on employee health and job perception in two countries with different organizational prerequisites. Moreover, managers' commitment and WOC were estimated by the managers themselves and did not rely on the employees' perception, which improved ecological validity.

Job Crafting, Employee Well-being, and Quality of Care.

The main objective is to study the effects of job crafting activities of elder care and nursing home employees on their perceived well-being and quality of care in two European countries, Spain and Sweden. The Job Crafting, the General Health, and the Quality of Care questionnaires were administered to 530 employees. Correlations and hierarchical regression analyses were performed. Results confirm the effects of job crafting on quality of care ( r = .291, p < .01; ß = .261, p < .01; Δ R2 = .065, p < .01) and employees' well-being ( r = .201, p < .01; ß = .171, p < .01; Δ R2 = .028, p < .01). A positive linear relationship was found between job crafting and well-being in Spain and Sweden and with quality of care in Spain. On the contrary, in Sweden, the relationship between job crafting and well-being was not linear. Job crafting contributes significantly to employees' and residents' well-being. Management should promote job crafting to co-create meaningful and productive work. Cultural effects are proposed to explain the differences found.

Understanding eldercare users' views on quality of care and strategies for dealing with problems in Swedish home help services.

The aim of the present study was to gain a deeper understanding of eldercare users' strategies for dealing with problems in the quality of care and care satisfaction in relation to home help services. Based on earlier research and evaluations, it was assumed that users would express satisfaction and gratitude, and also be unwilling to complain. The specific research questions were: (i) What, if any, quality of care problems do the users mention? (ii) How do the users explain the reasons for these problems? and (iii) What strategies do the users employ to deal with these problems? A total of 35 interviews were conducted in November 2013 with 15 men and 20 women (66-92 years). The data were analysed using thematic and qualitative content analysis. The results showed that almost all users expressed overall satisfaction with their care. However, all but one also mentioned problems. The users stated very clearly and explicitly the reasons for these problems, and in most cases, they referred to the work conditions, work organisation and lack of other resources in the eldercare organisation. Two strategies were commonly used to deal with these problems: trivialisation and adaptation. A third strategy was expressed dissatisfaction, where the problem led to actions or plans to take action. One interpretation of the findings is that what is actually measured in official quality assessments and follow-ups may be care users' understanding of the work conditions and work organisation of eldercare. The understanding attitude may prevent care users from complaining because it lowers their expectations.

From thought to action: young parents' reasons for participation in parenting support groups at child welfare centers.

In this article the focus is on young parents' engagement process in relation to participation in parenting support groups carried out at child welfare centers. This qualitative study focuses not only on young parents' reasons for participating or not participating in parenting support groups during different phases in their engagement process, but also on examining the circumstances that may contribute to such changes. The results show that these reasons can be divided into four categories: the staff, other participants, the social network, and practical circumstances. It also appears that these reasons change between different phases of their engagement process. Primarily three different circumstances contributed to variation in parents' reasons: difficulty in predicting the value of participation, increased closeness in relationships with staff and other parents, and the specific life phase in which young parents find themselves. The results have important implications for policy makers and practitioners in their work in formulating and updating parenting support; they also indicate what may be important to focus on in the recruitment of young parents, and also what may be crucial in regard to them completing their engagement in parent support groups.

Changes in commitment to change among leaders in home help services.

PURPOSE: The purpose of the this study was to explore the development of commitment to change among leaders in the home help services during organizational change and to study this development in relation to workload and stress. During organizational change initiatives, commitment to change among leaders is important to ensure the implementation of the change. However, little is known of development of commitment of change over time. DESIGN/METHODOLOGY/APPROACH: The study used a qualitative design with semi-structured interviews with ten leaders by the time an organizational change initiative was launched and follow-up one year later. Thematic content analysis was used to analyze the interviews. FINDINGS: Commitment to change is not static, but seems to develop over time and during organizational change. At the first interview, leaders had a varied pattern reflecting different dimensions of commitment to change. One year later, the differences between leaders' commitment to change was less obvious. Differences in commitment to change had no apparent relationship with workload or stress. RESEARCH LIMITATIONS/IMPLICATIONS: The data were collected from one organization, and the number of participants were small which could affect the results on workload and stress in relation to commitment to change. PRACTICAL IMPLICATIONS: It is important to support leaders during organizational change initiatives to maintain their commitment. One way to accomplish this is to use management team meetings to monitor how leaders perceive their situation. ORIGINALITY/VALUE: Qualitative, longitudinal and leader studies on commitment to change are all unusual, and taken together, this study shows new aspects of commitment.

The importance of leadership style and psychosocial work environment to staff-assessed quality of care: implications for home help services.

Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross-sectional survey design was used and a total of 469 questionnaires were distributed (March-April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.

"The balancing act"--licensed practical nurse experiences of falls and fall prevention: a qualitative study.

BACKGROUND: Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients. METHODS: A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis. RESULTS: The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients' appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients' risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer. CONCLUSIONS: Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.