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Psychosocial working conditions among general practitioners and district nurses: Organisational, professional and gender aspects
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis focuses on the psychosocial working conditions shared by general practitioners and district nurses in Sweden, in relation to the personal doctor reform and district nurses' right to prescribe drugs.

First, a questionnaire was compiled and developed through a stepwise development phase, including key informant interviews, literature review, and review of other models and questionnaires used with a similar purpose. The questionnaire developed was used in a pilot study with 42 general practitioners and 39 district nurses. The questionnaire with 78 items in different parts, was tested for construct validity through factor analysis, and for reliability through Cronbach's alpha. It was then used in the main study.

One aim was also to compare perceived changes in working conditions between general practitioners and district nurses during different degrees of implementation of a personal doctor system. A sample of 469 general practitioners and 466 district nurses participated. The cross-sectional design makes it difficult to distinguish the possible direct effects of a personal doctor from other regional differences. However, is it important to note that the personnel in a more far-reaching personal doctor system perceived less favourable psychosocial working conditions than personnel in a more traditional primary care system.

Another aim was to investigate gender and professional differences in the shared psychosocial working conditions. Both general practitioners and district nurses were satisfied with the professional content of their work and experienced rather low or moderate levels of strains -and symptoms. However, female general practitioners perceived the most unfavourable working conditions compared with both male colleagues and female district nurses.

The opinions among general practitioners and district nurses, to district nurses' right to prescribe drugs differed in all aspects studied. District nurses were positive and general practitioners negative. To gain a deeper understanding of the different opinions, six focus group interviews was carried out. The resistance to the refonn had turned into silence. General practitioners and district nurses hardly speak to each other about prescribing. The district nurses were uncertain whether the general practitioners trusted them and made up systems for self-control.

The personnel within a more far-reaching personal doctor system perceived less-favourable psychosocial working conditions compared with personnel in more traditional primary care system. Female general practitioners seem to experience the most unfavourable working conditions. compared with both their male counterparts, and female district nurses. District nurses prescribing highlights professional differences. Quantitative and qualitative data complement each other and give more diverse information.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2001. , 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 669
Keyword [en]
psychosocial working conditions, primary care, general practitioners, district nurses, profession, gender aspects, personal doctor reform, district nurses prescribing
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27556Local ID: 12218ISBN: 91-7219-962-8 (print)OAI: oai:DiVA.org:liu-27556DiVA: diva2:248108
Public defence
2001-05-04, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-06Bibliographically approved
List of papers
1. Assessment of Psychosocial Work Environment in Primary Care: Development of a Questionnaire
Open this publication in new window or tab >>Assessment of Psychosocial Work Environment in Primary Care: Development of a Questionnaire
1999 (English)In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 23, no 6, 447-456 p.Article in journal (Refereed) Published
Abstract [en]

Recent studies have indicated deteriorated working conditions of health care personnel. To have an efficient health care organization requires good working conditions and the well-being of the personnel. Today there are no 'gold-standard' assessment tools measuring psychosocial working conditions. The aim of this study was to develop two valid and reliable questionnaires, one generic and one specific, measuring psychosocial working conditions for general practitioners (GPs) and district nurses (DNs) in Sweden, with a special emphasis on organizational changes. The construction of the questionnaires were made after a stepwise developing phase including literature review, interviews, and a pilot study. The pilot study included GPs n = 42 and DNs n = 39. The questionnaires were later on used in a main study (GPs n = 465, DNs n = 465). A factor analysis was carried out and showed that there were fewer items in the main study that had factor loading ≥ 0.40 in more than one factor, compared to the pilot study. The factors from the main study were easier to label and had good correspondence with other studies. After this stepwise development phase good construct validity and internal consistency were established for the questionnaire.

Keyword
psychosocial working conditions, general practitioner, district nurses, questionnaire, factor analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-49807 (URN)10.1023/A:1020516914688 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12Bibliographically approved
2. The personal doctor reform in Sweden: perceived changes in working conditions
Open this publication in new window or tab >>The personal doctor reform in Sweden: perceived changes in working conditions
1998 (English)In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 15, no 3, 192-197 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In primary care in Sweden, several organizational changes have been implemented during the last decades in order to facilitate a shift from a high proportion of hospital care to a more primary-health-based care. The personal doctor reform has been one of the most important during recent years, for both personnel and patients.

OBJECTIVES: We aimed to compare perceived changes in psychosocial working conditions for GP and district nurses in regions with traditional primary care and regions that have implemented a personal doctor system.

METHODS: A questionnaire was mailed to 566 GPs and 554 district nurses in four selected county councils, two with traditional primary care and two with a personal doctor system. The overall response rate was 83%. A factor analysis of data concerning the experience of the organizational change revealed the following factors: fellowship at work, demands on the individual, influence and control, competence development and stimulation at work.

RESULTS AND CONCLUSIONS: In the group as a whole, there was a general experience of deterioration of working conditions in all aspects except stimulation at work. This tendency was mostly marked in the regions with a personal doctor system. In these regions, GPs and district nurses reported significantly more impairments concerning demands on the individual and competence development. In addition, the district nurses also found themselves less able to exercise influence and control. These changes are neither desirable nor necessary consequences of an organizational development. It is important to follow continuously the personnel's experience in a changing primary health care system.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81078 (URN)10.1093/fampra/15.3.192 (DOI)
Available from: 2012-09-06 Created: 2012-09-06 Last updated: 2017-12-07Bibliographically approved
3. Unfavourable Working Conditions for Female GPs: A Comparison between Swedish General Practitioners and District Nurses
Open this publication in new window or tab >>Unfavourable Working Conditions for Female GPs: A Comparison between Swedish General Practitioners and District Nurses
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: The aim of this study was to investigate gender and occupational differences in the psychosocial work environment among general practitioners (GPs) and district nurses (DNs) in Sweden.

Design: A stratified random sample of general practitioners (n = 566) and district nurses (n= 554) from four county councils in Sweden was selected. The overall participation rate was 83%. A mailed questionnaire including ten items of demographic and work sites characteristics, and 36 items of psychosocial working conditions was used. The questionnaire had been tested concerning validity and reliability. A factor analysis gave five factors: strains and symptoms, professional content, social support at work, workload, and job control.

Results: In total, professional content was the most positively experienced aspect whereas workload was the most negatively. The GPs perceived a higher workload and fewer opportunities to social support at work compared with the DNs. The female GPs scored significantly more unfavourable than both male GPs and female DNs did in four out of the five factors. The female GPs reported a high workload, low job control and fewer opportunities to social support at work. The female DNs also reported a high workload, relatively low job control but a rather strong social support at work.

Conclusion: Female GPs perceive more unfavourable psychosocial working conditions compared with both male GPs and female DNs in the same organisational setting.

Keyword
psychosocial working conditions, primary care, general practitioners, district nurses, females
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81081 (URN)
Available from: 2012-09-06 Created: 2012-09-06 Last updated: 2013-09-05Bibliographically approved
4. Opinions about district nurses prescribing
Open this publication in new window or tab >>Opinions about district nurses prescribing
2001 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 15, no 4, 326-330 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate the opinions of district nurses (DNs) and general practitioners (GPs) about nurse prescribing in Sweden in order to elucidate similarities and differences, and relate different opinions to background and psychosocial working factors. In a questionnaire about psychosocial working conditions, seven statements about DNs prescribing were included. The questionnaire was sent to 554 DNs and 566 GPs with a participant rate of 83%. On all items as well as on the total score DNs rated more positively compared with GPs. Amongst the DNs a positive opinion was related to a traditional primary care organization, age < 50, good social support at work, and high workload. A positive opinion amongst GPs was associated with working in a traditional primary care organization, being male GP, and a good social support at work. In a multiple regression analysis, occupation and organization were independently associated with the total score. The result shows a strong professional solidarity amongst GPs and seems to be based on concern about the profession rather than patient care.

Keyword
District nurses, General practitioner, Nurse prescribing, Opinions, Primary health care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47197 (URN)10.1046/j.1471-6712.2001.00036.x (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
5. Exploring views on Swedish district nurses' prescribing: a focus group study in primary health care
Open this publication in new window or tab >>Exploring views on Swedish district nurses' prescribing: a focus group study in primary health care
2003 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 5, 643-650 p.Article in journal (Refereed) Published
Abstract [en]

• Since 1994 district nurses (DNs) in Sweden have been permitted to prescribe drugs from a limited list. This reform has met severe resistance from doctors and the opinions of general practitioners (GPs) and DNs have differed in many aspects.

•  The aim of this study was to gain deeper understanding of the different opinions about DNs' prescribing and to explore the impact of the reform on primary care.

• Six focus group interviews were conducted, four with DNs and two with GPs.

•  Data analysis revealed six categories, which were condensed into two dimensions. The dimensions were individual prerequisites, with the categories responsibility and knowledge, and organizational prerequisites, with the categories distribution of work, climate of co-operation, resistance and economic considerations.

•  District nurses were very positive towards prescribing and had gained new knowledge through the compulsory training course and via discussions with pharmacists. Because of the responsibility required for prescribing, some nurses had introduced systems for self-monitoring. Prescribing was seen as a natural part of the nursing process. All interviewees could describe periods of resistance against the reform, and the head of the health centre was a key person for attitudes at the workplace.

• The DNs found the nurse prescribing reform very positive. They experienced a strengthening of professionalism and also thought that the reform was a natural development. Negative attitudes and opinions offset the positive feelings. The resistance that had appeared in the beginning had now turned into silent acceptance.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-28308 (URN)10.1046/j.1365-2702.2003.00716.x (DOI)13440 (Local ID)13440 (Archive number)13440 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved

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