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- Anskär, Eva, 1957-, et al.
(author)
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Legitimacy of work tasks, psychosocial work environment, and time utilization among primary care staff in Sweden
- 2019
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In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 37:4, s. 476-483
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Journal article (peer-reviewed)abstract
- Objective: Primary care staff faces a complex work environment including a heavy administrative work load and perceive some work tasks as illegitimate. This study aimed to elucidate associations between the perceived legitimacy of work tasks, the psychosocial work environment, and the utilization of work time among Swedish primary care staff.Design and setting: The study was designed as a multicenter study involving all staff categories, i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals, at eleven primary care centers in Sweden.Subjects: Participants completed the Bern Illegitimate Tasks Scale and the Copenhagen Psychosocial Questionnaire. They also recorded time spent on all work tasks, day by day during two separate weeks.Main outcome measures and results: More than a quarter (27%) of primary care physicians perceived a high proportion of unnecessary work tasks. After adjusting for profession, age and gender, the perception of having to perform unreasonable work tasks was positively associated with experiencing role conflicts and with the proportion of organization-related administration and service work tasks.Conclusion: Across all staff groups, the perception of unreasonable work tasks was more pronounced among staff with a high proportion of non-patient related administration. Also, the perception of having to perform a large amount of illegitimate work tasks affected the psychosocial work environment negatively, which might influence staffs perception of their professional roles. These results illuminate the importance of decision makers to thoroughly consider the distribution and allocation of non-patient related work tasks among staff in primary care.Key pointsWe observed an interaction between perception of having a large proportion of illegitimate work tasks and impaired psychosocial work environment. • More than a quarter of the primary care physicians perceived a high proportion of unnecessary work tasks.• Across all staff groups, performing unreasonable work tasks was associated with an experience of having role conflicts.• Across all staff groups, a perception of performing unreasonable work tasks was associated with the proportion of non-patient related administrative work tasks.
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| 2. |
- Anskär, Eva, 1957-
(author)
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Time flies in primary care : a study on time utilisation and perceived psychosocial work environment
- 2019
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Licentiate thesis (other academic/artistic)abstract
- Background: Time utilisation among primary care professionals has been affected by structural changes and reorganisation performed in Swedish primary care over several decades. The work situation is complex with a heavy administrative work load. The overall aim with this thesis was to describe time utilisation among staff in Swedish primary care and to investigate associations with perceived psychosocial work environment and legitimacy of work tasks.Methods: A multicentre, descriptive, cross-sectional study design was used including all staff categories in primary care i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals (physiotherapists, occupational therapists, psychologists, counsellors, dieticians and chiropodists) at eleven primary care centres located in southeast Sweden. The data collection consisted of a questionnaire including a subjective estimate of workload, the Bern Illegitimate Tasks Scale (BITS) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Also, a time study was performed, where the participants reported their work time based on three main categories; direct patient work tasks, indirect patient work tasks and other work tasks, each with a number of subcategories. The participants reported time spent on different work tasks, day by day during two separate weeks. Response rates were 75% for the questionnaire and 79% for the time study.Results: In paper I the time study revealed that health professionals at the primary care centres spent 37% of their work time with direct patient work tasks. All professions estimated a higher proportion of time spent directly with patients than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress and role conflicts. The proportion of administrative work tasks was associated with role conflicts, the more administration the more role conflicts. Findings in paper II were that more than a quarter of physicians scored above the cut-off value for BITS regarding unnecessary work tasks, which was significantly more than the proportion observed in all other professions in the survey. Across all staff groups, a perception of having to perform illegitimate work tasks was associated with experiencing negative psychosocial work environment and with high proportion of administrative-related work tasks.Conclusions: Swedish primary care staff spend a limited proportion of their work time directly with patients and primary care physicians perceive the psychosocial work environment in negative terms to a greater extent than all other staff members. Allocation of work tasks has an influence on the perceived psychosocial work environment. The perception of having a large number of illegitimate work tasks affects the psychosocial work environment negatively, which might influence the perception the staff have of their professional roles. Perception of high proportion of unreasonable work tasks is associated with a high proportion of non-patient-related administration.This thesis illuminates the importance of decision makers thoroughly considering the distribution and allocation of non-patient related work tasks among staff in primary care, in order to achieve efficient use of personnel resources and favourable working conditions. Hopefully, the results of this study will contribute to further development of primary care so that medical competence will benefit patients as much as possible.
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| 3. |
- Anskär, Eva, 1957-, et al.
(author)
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Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings
- 2018
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In: BMC Health Services Research. - : BIOMED CENTRAL LTD. - 1472-6963. ; 18
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Journal article (peer-reviewed)abstract
- Background: Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. Methods: This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. Results: All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of work-time spent on administrative tasks was associated with more role conflicts. Younger staff perceived more adverse working conditions than older staff. Conclusions: This study indicated that Swedish primary care staff spent a limited proportion of their work time directly with patients. PCPs seemed to perceive their work environment in negative terms to a greater extent than other staff members. This study showed that work task allocations influenced the perceived psychosocial work environment.
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| 4. |
- Carlfjord, Siw, 1959-, et al.
(author)
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Asthma and COPD in primary health care, quality according to national guidelines : A cross-sectional and a retrospective study
- 2008
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In: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 9
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Journal article (peer-reviewed)abstract
- Background. In recent decades international and national guidelines have been formulated to ensure that patients suffering from specific diseases receive evidence-based care. In 2004 the National Swedish Board of Health and Welfare (SoS) published guidelines concerning the management of patients with asthma and COPD. The guidelines identify quality indicators that should be fulfilled. The aim of this study was to survey structure and process indicators, according to the asthma and COPD guidelines, in primary health care, and to identify correlations between structure and process quality results. Methods. A cross-sectional study of existing structure by using a questionnaire, and a retrospective study of process quality based on a review of measures documented in asthma and COPD medical records. All 42 primary health care centres in the county council of Östergötland, Sweden, were included. Results. All centres showed high quality regarding structure, although there was a large difference in time reserved for Asthma and COPD Nurse Practice (ACNP). The difference in reserved time was reflected in process quality results. The time needed to reach the highest levels of spirometry and current smoking habit documentation was between 1 and 1 1/2 hours per week per 1000 patients registered at the centre. Less time resulted in fewer patients examined with spirometry, and fewer medical records with smoking habits documented. More time did not result in higher levels, but in more frequent contact with each patient. In the COPD group more time resulted in higher levels of pulse oximetry and weight registration. Conclusion. To provide asthma and COPD patients with high process quality in primary care according to national Swedish guidelines, at least one hour per week per 1000 patients registered at the primary health care centre should be reserved for ACNP. © 2008 Carlfjord and Lindberg, licensee BioMed Central Ltd.
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| 5. |
- Johnson, Christina, 1964-
(author)
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Telephone advice nursing : communication, patient satisfaction and tool development
- 2018
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Licentiate thesis (other academic/artistic)abstract
- Background: Telenursing has rapidly expanded in many countries. In Sweden, a national telephone advisory nursing service reaches the entire nation and receives approximately 4,5 million calls per year. The six phase nursing process – assessment, nursing diagnosis, setting goals, planning, implementation and evaluation – can be used when managing a caller’s health problem. In telenursing, a person-centred approach makes for more satisfied and appreciative callers. The core component of interaction is the verbal communication between the telenurse and caller. Several studies have revealed the need for the development of communication competence in telenursing. Structured analyses of conversations between telenurses and callers is one way to increase telenurses’ awareness of their communication and interpersonal competence. This type of analysis requires a valid formative self-assessment tool. To evaluate communicative effectiveness, the patient perspective of the interpersonal aspects of interaction are described as a necessary component, and satisfaction surveys designed for a telenursing context are recommended. Therefore, a questionnaire is needed that evaluates the effects of telenurse communication training from the caller’s perspective.Aims: The overall aim of these two studies was to develop tools to enable improvements and evaluations in communication and interpersonal competence in telenursing from the perspective of both the telenurse and the caller.Study 1: To develop a self-assessment tool aiming to raise telenurses’ awareness of their communication and interpersonal competence and highlight areas in need of improvement.Study 2: To develop and assess content validity of a theoretically anchored questionnaire that explores caller satisfaction in TAN as a result of the interaction between the caller and the telenurse.Methods: Study 1: The development and the evaluation of content validity of the Telenursing Self-Assessment Tool (TSAT) started with a literature search and domain identification, which were used to generate the items. The assessment of the content validity was performed in two steps. First, an expert group completed two rounds of assessments using Content Validity Index (CVI). Second, telenurses tested the tool and assessed the content validity using CVI. Thereafter, the telenurses participated in consensus discussions. Refinements of the tool were done after every assessment.Study 2: The development and the evaluation of content validity of the Telenursing Interaction and Satisfaction Questionnaire (TISQ) started with a literature search and domain identification, which were used to generate the items. The assessment of the content validity was performed in two steps. First, cognitive interviews were performed with the callers, the target population. Next, experts evaluated the content validity using CVI. Refinements of the tool were done after every assessment. The Interaction Model of Client Health Behavior (IMCHB) provided theoretical guidance and support.Results:Study 1: The TSAT with 58 items was developed. The items were structured according to the nursing process and the tool was judged as having good content validity.Study 2: The TISQ consisting of 60 items based on the IMCHB was developed. The questionnaire was found to exhibit good content validity.Conclusions: This thesis describes the development and assessment of content validity of two theoretically anchored tools aimed to improve and evaluate communication and interpersonal competence in telenursing from the perspective of both the telenurse and the caller. The TSAT is meant to create learning opportunities, to provide self-direction, feedback, and coaching, and to guide the telenurse through the nursing process using a person-centred approach. The TISQ aims to explore the callers’ satisfaction and the callers’ perceptions of the interaction with the telenurse. With better knowledge about this, communication improvement and education in telenursing can be tailored to enhance caller satisfaction.
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| 8. |
- Lindberg, Malou, 1957-, et al.
(author)
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Asthma nurse practice improves outcomes and reduces costs in primary health care
- 2002
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 16:1, s. 73-78
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Journal article (peer-reviewed)abstract
- Objective. The aim of this study was to elucidate the care of patients with asthma in primary health care from medical, patient self-management, health, quality of live, and health economic perspectives.Methods. Asthma nurse practice (ANP), an alternative asthma self-management strategy, was compared with traditional asthma care in primary health care in southern Sweden regarding medical history, lifestyle, self-management, symptoms caused by asthma, effects on sick leave, state of health, quality of life and health care costs. The first part of the investigation comprised a retrospective study of a randomly selected sample of patient records of asthmatics (n=152). The second part, lasting 3 months, was prospective and included consecutive patients visits (n=347).Results. The ANP approach showed better results in most of the evaluated outcomes such as asthma quality documentation and self-management and the number of asthma symptoms was significantly lower. From a health economic perspective the results were encouraging with respect to ANP.Conclusion. This alternative asthma strategy, ANP, improved asthma care in primary health care and resulted in economic advantages in the health care sector. However the result may only be generalized to other practices working with asthma nurses in the same way.
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| 9. |
- Lindberg, Malou, 1957-
(author)
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Asthma nurse practice in primary health care : quality, costs and outcome
- 2001
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Doctoral thesis (other academic/artistic)abstract
- The primary aim of the present work was to document and analyse whether it is beneficial to patients and to the health care sector to organise asthma care in primary health care is the form of asthma nurse practices (ANPs). During the past decade ANPs have been established in primary health care in the county of Östergatland, Sweden. The prevalence of asthma is increasing in the industrialised world, and this focuses attention on the efficacy and quality of asthma care.The methods, data collection and measurements that were used can be summarised as follows. The studies included: (i) a prospective intervention study (ANP concept) with pre- and post- test comparisons, objective measurements and patient questionnaires; (ii) further development of a patient questionnaire, validation of items by structured followHup telephone interviews using predetermined criteria; (iii) comparison of quality and cost in two different approaches to providing asthma care within primary health care, traditional care and care given at a primary health care centre with an ANP, by combining a retrospective review of documentation in patient records using a special form and a prospective approach using a patient questionnaire; (iv) semi-structured interviews with asthma patients to obtain their view of asthma care and clarify factors of importance for compliance with prescribed medication.The evaluation demonstrated that on the group level, primary health care centres with ANPs resulted in better disease control, fewer asthma symptoms, and better patient experienced knowledge and self-management outcomes. The results also showed fewer emergency visits, better documentation of asthma management and better asthma quality outcomes. It was also found that health care costs were lower with the ANP than with traditional asthma care in primary health care. The patients expressed important aspects of the care as the need for security, including regular asthma check-ups, easy access to care, continuity in the care, competence ofthe health care staff, and information and knowledge about asthma. Increasing age, female gender, long duration of the disease, the attitude of the staff, and whether patients felt they had obtained information and education about asthma were all factors of importance for compliance with prescribed medication.The main conclusion of the thesis was that the ANP concept seems to improve asthma care in primary health care and resulted in economic advantages for the health care sector.
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