OJN  Vol.5 No.9 , September 2015
Consequences of Working in Eldercare during Organizational Changes and Cut Backs While Education and Clinical Supervision Was Provided: A Mixed Methods Study
Abstract: Background: Reorganization and downsizing can disrupt a competent staff and conflicts can arise between what the employee is being asked to do and their knowledge and competences. Reduced job satisfaction among nursing home staff with increased workload and strain can occur. Aim and Objectives: The aim was to investigate the organizational climate and prevalence of burnout symptoms among caregivers over time in three Swedish nursing homes (NH I-III) undergoing organizational changes, while education and clinical supervision were provided. Design: The study design combines qualitative and quantitative methods in a longitudinal two-year follow-up project in NH I-III. Methods: Support through education and clinical supervision was provided for caregivers only at NH I and NH II. At NH I-III caregiver self-assessments and interviews were completed and analysed three different times. Results: NH I revealed improvement and increased innovation over time, while NH II showed a decline with no ability to implement new knowledge. NH III retained a more status quo. Conclusions: Organizational changes and cutbacks, occurring at different times, appeared to cause major stress and frustration among the three personnel groups. They felt guilty about not meeting their perceived obligations, seemed to have lost pride in their work but kept struggling. The changes seemed to over-shadow attempts to improve working conditions through education and clinical supervision initially. Implications for practice: It will be important to learn from reorganizations and the consequences they will have for the staff and quality of care. Important topics for future research are to study financial cutbacks and changes in organizational processes in care of older people to be able to develop a more person centered care for older people.
Cite this paper: Fläckman, B. , Skovdahl, K. , Fagerberg, I. , Kihlgren, M. and Kihlgren, A. (2015) Consequences of Working in Eldercare during Organizational Changes and Cut Backs While Education and Clinical Supervision Was Provided: A Mixed Methods Study. Open Journal of Nursing, 5, 813-827. doi: 10.4236/ojn.2015.59086.

[1]   Dahl, H.M. (2009) New Public Management, Care and Struggles about Recognition. Critical Social Policy, 29, 634-654.

[2]   Trydegård, G.-B. (2012) Care Work in Changing Welfare States: Nordic Care Workers’ Experiences. European Journal of Ageing, 9, 119-129.

[3]   Dwyer, L.-L., Andershed, B., Nordenfeldt, L. and Ternestedt, B.-M. (2009) Dignity as Experienced by Nursing Home Staff. International Journal of Older People Nursing, 4, 185-193.

[4]   Häggström, E., Mamhidir, A.-G. and Kihlgren, A. (2010) Caregiver’s Strong Commitment to Their Relationship with Older People. International Journal of Nursing Practice, 16, 99-105.

[5]   Suhonen, R., Stolt, M., Virtanen, H. and Leino-Kilpi, H. (2011) Organizational Ethics: A Literature Review. Nursing Ethics, 18, 285-303.

[6]   Fagerberg, I. and Engström, G. (2012) Care of the Old—A Matter of Ethics, Organization and Relationship. International Journal of Qualitative Studies on Health and Well-Being, 7, 9684.

[7]   Petterson, I.-L., Donnersvärd, H.Å., Lagerström, M. and Toomingas, A. (2006) Evaluation of an Intervention Programme Based on Empowerment for Eldercare Nursing Staff. Work and Stress, 20, 353-369.

[8]   Kihlgren, M. and Hansebo, G. (2014) Organizational Change and Supervision. In: Watkins Jr., C. and Milne, D.L., Eds., The Wiley International Handbook of Clinical Supervision, John Wiley & Sons, Ltd., West Sussex, 155-176.

[9]   Berggren, I. and Severinsson, E. (2003) Nurse Supervisors’ Actions in Relation to Their Decision-Making Style and Ethical Approach to Clinical Supervision. Journal of Advanced Nursing, 41, 615-622.

[10]   Nilsson, A. and Engström, M. (2015) E-Assessment and an e-Training Program among Elderly Care Staff Lacking Formal Competence: Results of a Mixed-Methods Intervention Study. BMC Health Services Research, 15, 189

[11]   Berggren, I., Barbosa da Silva, A. and Severinsson, E. (2005) Core Ethical Issues of Clinical Nursing Supervision. Nursing and Health Services, 7, 21-28.

[12]   Johansson, G., Andersson, L., Gustafsson, B. and Sandahl, C. (2010) Between Being and Doing—The Nature of Leadership of First-Line Nurse Managers and Registered Nurses. Journal of Clinical Nursing, 19, 2619-2628.

[13]   The Swedish National Board of Health and Welfare (2004) Vård och omsorg om äldre—En läges rapport 2004 [Caring for Older People—A Situation Report 2004]. Socialstyrelsen, Stockholm. (In Swedish)

[14]   The Swedish National Board of Health and Welfare (2012) Vård och omsorg om äldre—En läges rapport 2012 [Caring for Older People—A Situation Report 2012]. Socialstyrelsen, Stockholm. (In Swedish)

[15]   The Swedish National Board of Health and Welfare (2009) Vård och omsorg om äldre—En läges rapport 2009 [Caring for Older People—A Situation Report 2009]. Socialstyrelsen, Stockholm. (In Swedish)

[16]   Josefsson, K. and Hansson, M. (2011) To Lead and to Be Led in Municipal Elderly Care in Sweden as Perceived by Registered Nurses. Journal of Nursing Management, 19, 498-506.

[17]   Fagerberg, I. and Gilje, F. (2007) A Comparison of Curricular Approaches of Care of the Aged in Swedish and US Nursing Programs. Nurse Education in Practice, 7, 358-364.

[18]   Maslach, C., Jackson, S.E. and Leiter, P. (1996) Maslach Burnout Inventory Manual. Consulting Psychologists Press, Palo Alto.

[19]   Ekstedt, M. and Fagerberg, I. (2005) Lived Experiences of the Time Preceding Burnout. Journal of Advanced Nursing, 49, 59-67.

[20]   Vinje, H.F. and Mittelmark, M.B. (2007) Job En-gagement’s Paradoxical Role in Nurse Burnout. Nursing and Health Sciences, 9, 107-111.

[21]   Ekvall, G. (1987) The Climate Metaphor in Organization Theory. In: Bass, B. and Drenth, P., Eds., Advances in Organizational Psychology, Sage, Beverly Hills, 177-190.

[22]   Ekvall, G. (1996) Organizational Climate for Creativity and Innovation. European Journal of Work and Organizational Psychology, 5, 105-123.

[23]   Hertting, A., Nilsson, K., Theorell, T. and Sätterlund Larsson, U. (2004) Downsizing and Reorganization: Demands, Challenges and Ambiguity for Registered Nurses. Journal of Advanced Nursing, 45, 145-154.

[24]   Cresswell, J.W. and Plano Clark, V.L. (2007) Designing and Conducting Mixed Method Research. Sage Publications Inc., Thousand Oaks.

[25]   Fläckman, B., Fagerberg, I., Häggström, E., Kihlgren, A. and Kihlgren, M. (2007) Despite Shattered Expectations a Willingness to Care for Elders Remains with Education and Clinical Supervision. Scandinavian Journal of Caring Science, 21, 379-389.

[26]   Lövgren, G., Rasmussen, B.H. and Engström, B. (2002) Working Conditions and the Possibility of Providing Good Care. Journal of Nursing Management, 10, 201-209.

[27]   Norberg, K.-G., Hellzén, O., Sandman, P.-O. and Asplund, K. (2002) The Relationship between Organizational Climate and the Content of Daily Life People with Dementia Living in a Group-Dwelling. Journal of Clinical Nursing, 11, 237-246.

[28]   Söderlund, M., Norberg, A. and Hansebo, G. (2014) Validation Method Training: Nurses’ Experiences and Ratings of Work Climate. International Journal of Older People Nursing, 9, 79-89.

[29]   Hallsten, L. (1985) Burnout. A Study about Adaption and Development Processes in a Bureaucracy [Burnout. En studie kring anpassning och utvecklings processer I en byråkrati]. Rapport 18:2, LAMI Arbetsmarknadsinstitutet, Länsarbetsnämnden I Stockholms Läns, Stockholm. (in Swedish)

[30]   Maslach, C. and Jackson, S.E. (1981) The Measurement of Experienced Burnout. Journal of Occupational Behaviour, 2, 99-113.

[31]   Kvale, S. (1997) The Qualitative Research Interview [Den kvalitativa forsknings intervjun]. Studentlitteratur, Lund. (in Swedish)

[32]   Polit, D.F. and Beck, C.T. (2008) Nursing Research. Principles and Methods. 7th Edition, Lippincott Williams & Wilkins, Philadelphia.

[33]   Hsieh, H.-F. and Shannon, S.E. (2005) Three Approaches to Qualitative Content Analysis. Qualitative Health Research, 15, 1277-1288.

[34]   Juthberg, C., Eriksson, S., Norberg, A. and Sundin, K. (2008) Stress of Conscience and Perceptions of Conscience in Relation to Burnout among Care-Providers in Older People. Journal of Research in Nursing, 17, 1897-1906.

[35]   Glasberg, A.L., Eriksson, S. and Norberg, A. (2007) Burnout and “Stress of Conscience” among Healthcare Personnel. Journal of Advanced Nursing, 57, 392-403.

[36]   Jones, A. (2006) Clinical Supervision: What Do We Know and What Do We Need to Know? A Review and Commentary. Journal of Nursing Management, 14, 577-585.

[37]   Cummins, A. (2009) Clinical Supervision: The Way Forward? A Review of the Literature. Nurse Education in Practice, 9, 215-220.

[38]   Butterworth, T., Bell, L., Jackson, C. and Pajnkihar, M. (2008) Wicked Spell or Magic Bullet? A Review of the Clinical Supervision Literature 2001-2007. Nurse Education Today, 28, 264-272.

[39]   Nolan, M., Davies, S., Brown, J., Wilkinson, A., Warnes, T., McKee, K., Flannery, J. and Stasi, K. (2008) The Role of Education and Training in Achieving Change in Care Homes: A Literature Review. Journal of Research in Nursing, 13, 411-433.

[40]   Schaufeli, W.B. and Buunk, B.P. (1996) Burnout: An Overview of 25 Years of Research and Theorizing. In: Schabracq, M.J., Winnubst, J.A.M. and Cooper, C.L., Eds., Handbook of Work and Health Psychology, John Wiley & Son Ltd., Chichester, 383-425.

[41]   Schaufeli, W.B., Bakker, A.B. and Van Rhenen, W. (2009) How Changes in Job Demands and Resources Predict Burnout, Work Engagement, and Sickness Absenteeism. Journal of Organizational Behavior, 30, 893-917.

[42]   Schaufeli, W.B. and Bakker, A.B. (2004) Job Demands, Job Resources, and Their Relationship with Burnout and Engagement: A Multi-Sample Study. Journal of Organizational Behavior, 25, 293-515.

[43]   Hannigan, B., Edwards, D., Coyle, D., Fothergill, A. and Burnard, P. (2000) Burnout in Community Mental Health Nurses: Findings from the All-Wales Stress Study. Journal of Psychiatric and Mental Health Nursing, 7, 127-134.

[44]   Hyrkäs, K. (2005) Clinical Supervision, Burnout, and Job Satisfaction among Mental Health and Psychiatric Nurses in Finland. Issues in Mental Health Nursing, 26, 531-556.

[45]   Edwards, D., Burnard, P., Urnard, P., Hannigan, B., Cooper, L., Adams, J., Juggessur, T., Fothergil, A. and Coyle, D. (2006) Clinical Supervision and Burnout: The Influence of Clinical Supervision for Community Mental Health Nurses. Journal of Clinical Nursing, 15, 1007-1015.

[46]   Begat, I. and Severinsson, E. (2006) Reflection on How Clinical Nursing Supervision Enhances Nurses’ Experiences of Well-Being Related to Their Psychosocial Work Environment. Journal of Nursing Management, 14, 610-616.

[47]   Choi, J.S. and Johantgen, M. (2012) The Importance of Supervision in Retention of CNAs. Research in Nursing & Health, 35, 187-199.

[48]   Hyrkäs, K., Appelqvist-Schmidlechner, K. and Haataja, R. (2006) Efficacy of Clinical Supervision: Influence on Job Satisfaction, Burnout and Quality of Care. Journal of Advanced Nursing, 55, 521-535.

[49]   Sellgren, S.F., Ekvall, G. and Tomson, G. (2008) Leadership Behaviour of Nurse Managers in Relation to Job Satisfaction and Work Climate. Journal of Nursing Management, 16, 578-587.

[50]   Morgan, D.G. and Stewart, N.J. (2002) Focus on Research Methods, Theory Building through Mixed-Method Evaluation of a Dementia Special Care Unit. Research in Nursing & Health, 25, 479-488.

[51]   Szabo, V. and Strang, V.R. (1997) Secondary Analysis of Qualitative Data. Advances in Nursing Science, 20, 66-74.

[52]   Burns, N. and Grove, S.K. (2001) The Practice of Nursing Research, Conduct, Critique, and Utilization. 4th Edition, W.B. Saunders Company, Philadelphia.