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Lindmark, T., Trygged, S. & Engström, M. (2025). Does type of provider matter for staff well-being? A cross-sectional study of residential care home workers’ job demands and resources. Work: A journal of Prevention, Assessment and rehabilitation
Open this publication in new window or tab >>Does type of provider matter for staff well-being? A cross-sectional study of residential care home workers’ job demands and resources
2025 (English)In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270Article in journal (Refereed) Accepted
Abstract [en]

BACKGROUND: Marketisation trends have introduced new elements in residential care homes, potentially related to the psychosocial work environment and well-being of care workers. OBJECTIVE: This study examines differences in job demands and resources across public, outsourced, and private residential care home providers and their associations with care workers’ burnout, job satisfaction, and turnover intentions. METHODS: Data from 253 care workers across 19 residential care homes in three municipalities were analysed using a cross-sectional design, with a 45.3% response rate. We applied the Job Demands-Resources theory and the Copenhagen psychosocial questionnaire, conducting analyses of variance to assess differences and multiple regressions using Generalised Estimating Equations, accounting for the nested structure of the data. RESULTS: Our findings were mixed, with job demands and resources differing across provider types. Outsourced care workers reported higher emotional demands than public sector ones, while private providers offered greater autonomy and supervisor support than public ones. Outsourced workers rated higher levels of burnout than those in public settings, although this difference was non-significant after adding other factors to the model. Statistically significant differences in burnout levels were observed between municipalities. Private care workers reported higher job satisfaction than public ones. About 60% of respondents sometimes or more frequently considered leaving their jobs. Public care workers reported higher turnover intentions than those working for for-profit providers. CONCLUSIONS: This study contributes to understanding how provider type, job demands, and resources relate to care workers' well-being. Further comparative research could help clarify the impact of municipal differences versus provider types.

Place, publisher, year, edition, pages
IOS Press, 2025
Keywords
Assistant Nurses; Burnout, Psychological; Job Satisfaction; Nursing Homes; Ownership; Personnel Turnover; Psychological Well-Being; Working Conditions
National Category
Social Work
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-44827 (URN)10.1177/10519815241300294 (DOI)
Available from: 2024-06-20 Created: 2024-06-20 Last updated: 2025-01-28Bibliographically approved
Lundin, K., Skytt, B., Silén, M., Engström, M. & Strömberg, A. (2025). First-line managers’ experiences of and reflections on structural conditions for management practice in hospital settings. Leadership in Health Services, 38(5), 1-15
Open this publication in new window or tab >>First-line managers’ experiences of and reflections on structural conditions for management practice in hospital settings
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2025 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 38, no 5, p. 1-15Article in journal (Refereed) Published
Abstract [en]

Purpose

The purpose of this paper is to describe first-line managers’ (FLMs’) experiences and reflections on structural conditions for management practice within hospital settings using Kanter’s theory of structural empowerment.

Design/methodology/approach

A qualitative deductive approach with a descriptive design was used. Interviews were conducted with 11 FLMs in charge of medical or surgical hospital units spread across Sweden. Data were analyzed using a directed content analysis, based on Kanter’s theory of structural empowerment, encompassing such as access to necessary and sufficient resources, information, support and opportunities to learn and develop.

Findings

Findings of this study from the FLMs’ descriptions and reflections shed light on the impact of power dynamics on the structural conditions for management practice. The availability of nursing staff was a fundamental resource in the FLMs’ work performance, ensuring delivery of care to patients and a sound work environment for staff. Additionally, the other structural elements outlined in Kanter’s theory were evident in the findings, as the FLMs wished for structured information flow, identified potential and challenged opportunities for development and emphasized the importance of receiving support from people with a genuine understanding of their work situation.

Originality/valueThe results of this study contribute to the understanding of FLMs’ structural conditions for management practice in hospital settings. The paper’s originality stems from the use of a deductive approach, providing a structured lens with the potential to inform future research and practice in the field of health-care management.

Place, publisher, year, edition, pages
Emerald, 2025
Keywords
hospitals, leaders, managaement, working conditions, qualitative research, nurses
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-46202 (URN)10.1108/lhs-07-2024-0060 (DOI)001379344200001 ()39692171 (PubMedID)2-s2.0-85213333402 (Scopus ID)
Available from: 2024-12-18 Created: 2024-12-18 Last updated: 2025-01-07Bibliographically approved
Pinho, L. G., Engström, M., Schneider, B. C., Fonseca, C., Lindberg, M., Schröder, J., . . . Nilsson, A. (2025). Symptoms of anxiety and depression among health and social science students: A multicenter study. Heliyon, 11(2), Article ID e41957.
Open this publication in new window or tab >>Symptoms of anxiety and depression among health and social science students: A multicenter study
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2025 (English)In: Heliyon, E-ISSN 2405-8440, Vol. 11, no 2, article id e41957Article in journal (Refereed) Published
Abstract [en]

Background

The mental health of university students is a global concern, with high rates of depression and anxiety that need to be addressed.AimWe aimed to compare the mental health of Portuguese, Swedish and German university students in the health and social sciences following the Covid-19 pandemic and to analyze the factors associated with depressive and anxious symptoms in each country.

Methods

A cross-sectional study with a sample of students from Portugal, Germany and Sweden was conducted. Data from online questionnaires, including a sociodemographic and clinical questionnaire, the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder (GAD-7) and the MHI-5 (Mental Health Inventory) was collected from October to December 2022.

Results

The sample was composed of 1670 university students. The prevalence of mild to severe depressive symptoms was 72.7 % in Germany, 62.9 % in Sweden, and 60.3 % in Portugal and the prevalence of mild to severe anxiety symptoms was 78.6 % in Portugal, 73.7 % in Germany, and 66.9 % in Sweden. Being a female student, having a previous mental health disorder diagnosis, and poor academic performance were associated with higher severity of depression and anxiety symptoms in all three countries. Country-specific factors associated with more depressive and/or anxiety symptoms were younger age, smoking, low socioeconomic level and living away from home. Swedish students who do not consume alcohol had more anxiety symptoms and German students who do not consume alcohol had more depressive symptoms.

Conclusion

The high prevalence of depressive and anxiety symptoms among students in the three countries highlights the need to address modifiable factors that contribute to this mental health burden. Our results, which are in line with international trends, underline the need for policy reforms that target the main determinants of mental health, in particular by improving socio-economic conditions. Addressing these factors could play a crucial role in improving mental health outcomes in this population.

Place, publisher, year, edition, pages
Elsevier, 2025
Keywords
University students, Anxiety, Depression, Mental health, Cross-sectional study
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-46330 (URN)10.1016/j.heliyon.2025.e41957 (DOI)39897836 (PubMedID)2-s2.0-85215127756 (Scopus ID)
Projects
Psyksik hälsa hos studenter inom högre utbildning
Available from: 2025-01-20 Created: 2025-01-20 Last updated: 2025-02-07Bibliographically approved
Skytt, B., Högberg, H. & Engström, M. (2024). An explorative and confirmative factor analysis of the Leadership and Management Inventory-II among staff working in elderly care. Leadership in Health Services, 37(5), 66-83
Open this publication in new window or tab >>An explorative and confirmative factor analysis of the Leadership and Management Inventory-II among staff working in elderly care
2024 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 37, no 5, p. 66-83Article in journal (Refereed) Published
Abstract [en]

Purpose

The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden.

Design/methodology/approach

Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061).

Findings

The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results.

Originality/value

The instrument measures both leadership and management performance and can be used to continually measure managers’ performances as perceived by staff to identify areas for development.

Place, publisher, year, edition, pages
Emerald, 2024
Keywords
Health leadership competencies; Leadership; Management; Nurses; Statistical analysis
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-43286 (URN)10.1108/lhs-01-2023-0004 (DOI)001101160900001 ()37962108 (PubMedID)2-s2.0-85176883614 (Scopus ID)
Available from: 2023-11-16 Created: 2023-11-16 Last updated: 2024-01-24Bibliographically approved
Bjuhr, M., Lindberg, M., Engström, M., Welmer, A.-K. & Sjölund, B.-M. (2024). Antecedents of and experiences with voluntary early exit from working life before the expected retirement age in Sweden. Work: A journal of Prevention, Assessment and rehabilitation
Open this publication in new window or tab >>Antecedents of and experiences with voluntary early exit from working life before the expected retirement age in Sweden
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2024 (English)In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND:In most Western countries, senior workers have increased their participation in the workforce. However, at the same time, early retirement also increases. The reasons behind this early exit from the workforce are still unclear.

OBJECTIVE:This qualitative study aims to explore the antecedents of and experiences with a voluntary exit from working life before the expected retirement age of 65 in Sweden.

METHODS:Data consist of semi-structured interviews with 18 participants who exited working life between the ages of 61–63. In Sweden, these ages are considered as an early exit from working life since, for many years, the expected retirement age has been 65. Qualitative content analysis with an abductive approach was utilized.

RESULTS:The analysis revealed four sub-themes: 1) Health benefits with an early exit from working life (with the categories: own health status, the possibility for recovery time, and avoidance of strain); 2) Having economic conditions that enable an early exit from working life (with the categories: offers from the employer and financial compromises); 3) Social benefits with an early exit from working life (with the categories: enabling more time with my social network and avoidance of unsatisfying social work environment); 4) Self-fulfillment activities during the senior years (with the categories: enabling time for activities beyond work and avoidance of decreased job satisfaction.

CONCLUSION:This variety of antecedents of and experiences with a voluntary early exit from working life before the expected retirement age highlights that the ongoing increased statutory retirement age also increases the risk for extended inequalities among the aging population.

Place, publisher, year, edition, pages
IOS Press, 2024
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-42876 (URN)10.3233/wor-240176 (DOI)39240613 (PubMedID)
Available from: 2023-08-23 Created: 2023-08-23 Last updated: 2024-10-07Bibliographically approved
Bjuhr, M., Engström, M., Welmer, A.-K., Elmståhl, S. & Sjölund, B.-M. (2024). Being active in working life at age 60, 66 and 72 - a study of two Swedish cross-sectional samples 12 years apart. Nordic Journal of Work Life Science, 14(4), 5-22
Open this publication in new window or tab >>Being active in working life at age 60, 66 and 72 - a study of two Swedish cross-sectional samples 12 years apart
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2024 (English)In: Nordic Journal of Work Life Science, ISSN 2245-0157, Vol. 14, no 4, p. 5-22Article in journal (Refereed) Published
Abstract [en]

This study examines associations between participation in working life and sociodemographic, health, and work environment factors among people aged 60, 66, and 72 years. The agestratified logistic regression analysis used data from 2001–2003 (T1) and 2013–2015 (T2) derived from The Swedish National Study on Ageing and Care. Further, interaction variables with time*independent variables explored differences in those associations over time. We found positive associations between being active in working life and male gender (age 66 and 72), higher education (all age groups), higher professional level (age 60 and 66), better health (age 60 and 66), less negative work experiences (mainly age 60), light level of physical activity at work (age 60 and 66), higher work satisfaction (age 60 and 66), and time: that is,T2 vs.T1 (all age groups). Not only health status but also work environment factors were shown to play a significant role in being active in working life at older ages. Our findings verify that authorities need to develop reforms aiming at keeping older people active in working life from a heterogeneous perspective.

Place, publisher, year, edition, pages
VIA University College, 2024
Keywords
Health, Working Environment & Wellbeing, Gender, Ethnicity, Age and Diversity
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-42875 (URN)10.18291/njwls.145295 (DOI)001377301900002 ()
Available from: 2023-08-23 Created: 2023-08-23 Last updated: 2024-12-25Bibliographically approved
Eriksson, E., Högstedt, D., Engström, M. & Jansson, I. (2024). Breddad rekrytering- en utmaning för kommunikationen mellan studenter och handledare under VFU. In: : . Paper presented at NU 2024: Högre utbildning i och för förändring, 17-19 juni, Umeå universitet.
Open this publication in new window or tab >>Breddad rekrytering- en utmaning för kommunikationen mellan studenter och handledare under VFU
2024 (Swedish)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [sv]

Bakgrund: Breddad rekrytering och ökad invandring möjliggör att fler studenter blir antagna inom högskolan som har ett annat modersmål än svenska. För legitimerade yrken krävs en komplettering när den sökande kommer från länder utanför EU/EES och Schweiz. Antalet sjuksköterskor i Sverige med examen utanför EU/EES ökar och vi behöver tillvarata denna kompetens genom att ge dem de bästa förutsättningarna att få en svensk legitimation. Sjuksköterskor som genomgår kompletterande utbildning upplever att de kan ha svårt att kommunicera på svenska och att de ibland saknar stöd under sin VFU. Handledares erfarenheter av kommunikation med studenter som har svenska som andraspråk är mindre studerat.

Syfte: Att studera handledares erfarenheter av att handleda studenter som går den kompletterande utbildningen för sjuksköterskor med examen utanför EU under sin VFU.

Metod: Studien genomfördes vid två lärosäten i Sverige som erbjuder kompletteringsutbildning för sjuksköterskor med sjuksköterskeexamen utanför EU. Femton semistrukturerade intervjuer genomfördes och analyserades med kvalitativ innehållsanalys.

Resultat: Att handleda studenter med utländsk examen var annorlunda, vilket upplevdes som roligt men också frustrerande. Studenternas språkkunskaper i svenska var ofta bristande vilket kunde försvåra kommunikationen och bidra till en ansträngd relation mellan handledaren och studenten. Handledarna upplevde också att det kunde finnas vårdkulturell skillnad i hur man kommunicerar mellan professioner och med patienter. Däremot var det tillfredställande när studenten utvecklade såväl sina språkkunskaper som sin roll som sjuksköterska i svensk kontext under VFU. 

National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-45874 (URN)
Conference
NU 2024: Högre utbildning i och för förändring, 17-19 juni, Umeå universitet
Available from: 2024-10-23 Created: 2024-10-23 Last updated: 2024-10-23Bibliographically approved
Lundin, K., Engström, M., Strömberg, A., Silén, M. & Skytt, B. (2024). First-line managers' span of control in hospital settings. In: : . Paper presented at Sustainable HRM and Working-Life Practices, 17-19 June, 2024, Gothenburg, Sweden.
Open this publication in new window or tab >>First-line managers' span of control in hospital settings
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2024 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Background

Span of control (SOC) has been used as a description of the number of individual employees that a manager is responsible for and is often used for assessing first-line managers' (FLMs') scope of responsibilities. However, there are arguments that SOC should include more factors than number of direct reports to illustrate the diversity and complexity of FLMs' responsibilities in hospital settings. Mentions of being an objective instrument including such factors have been made of 'The Ottawa Hospital Clinical Managers Decision-Making Tool' (TOH-SOC) which includes three decision-making categories: unit-, staff- and program-focused. The unit-focused category includes two indicators: unit complexity and material management. The staff-focused category includes four indicators: volumes of staff directly reporting to the FLM, autonomy of the team, staffing stability, and diversity of staff. The program-focused category includes two indicators: diversity and budgetary responsibilities. The TOH-SOC tool is referred to in both international reviews and Swedish reports as an instrument for assessing FLMs' scope of responsibilities, but published results from using it are limited. Hence, there is a need to further test the instrument's validity, reliability, and generalizability in different settings and countries. 

Aim

The aim of this study is to investigate how the TOH-SOC describes the span of control of hospital first-line managers at medical and surgical units in Sweden and what descriptions and reflections first-line managers have regarding the instument's content validity and clinical usefulness.

Methods

A mixed method design with an explanatory sequential approach is used and includes three stages; the first is quantitative data collection and analysis, the second is asking how the results from stage one can be used in stage three, which, last and ongoing, includes a quantitative and qualitative data collection and analysis. The participants in stage one was driven from a randomized sample of Swedish hospital FLMs at medical and surgical units, and in stage three, the participants consisted of a subsample of FLMs included in stage one. Descriptive statistics are used to describe respondents' demographics and their span of control. From the interviews, quantitative and qualitative viewpoints on the TOH-SOC is analyzed with the standard method for computing an item-level content validity index (I-CVI) .78 or higher and qualitative content analysis.

Results

Results from the first stage showed how the majority out of the total 33 FLMs scored as having an appropriate span of control, according to the scoring guidelines described in the TOH-SOC tool. Although the results from the first stage are in line with earlier research, questions for clarification regarding the instrument have been identified. These questions, along with initial results from the second and last stage, identifying how norms differ between the origin of the instrument and the Swedish context, imply a need to further test and develop the instrument to be relevant in hospital context and, in particular, Swedish hospital medical and surgical units. More detailed results will be presented later this year.

Keywords
span of control, hospital, nurse manager, mixed method
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-46160 (URN)
Conference
Sustainable HRM and Working-Life Practices, 17-19 June, 2024, Gothenburg, Sweden
Available from: 2024-12-12 Created: 2024-12-12 Last updated: 2024-12-13Bibliographically approved
Björkman, A., Engström, M., Skytt, B., Nilsson, A., Tao, R. & Xu, L. (2024). From on-site education and examination in Lishui, China of Swedish lecturer to seminars and examination via Zoom. In: Kolbrún Sigurlásdóttir (Ed.), : . Paper presented at Nordic Forum for Nurse Educators 2024, November 11 - 13, 2024,  University of Akureyri, Iceland.
Open this publication in new window or tab >>From on-site education and examination in Lishui, China of Swedish lecturer to seminars and examination via Zoom
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2024 (English)In: / [ed] Kolbrún Sigurlásdóttir, 2024Conference paper, Oral presentation with published abstract (Refereed)
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-45342 (URN)
Conference
Nordic Forum for Nurse Educators 2024, November 11 - 13, 2024,  University of Akureyri, Iceland
Funder
University of Gävle
Available from: 2024-08-15 Created: 2024-08-15 Last updated: 2024-08-20Bibliographically approved
Lundin, K., Engström, M., Skytt, B., Strömberg, A. & Silén, M. (2024). Individual and unit level insights from hospital staff ratings on structural empowerment, leadership-management performance, well-being, and quality of care. BMC Health Services Research, 24(1), Article ID 1491.
Open this publication in new window or tab >>Individual and unit level insights from hospital staff ratings on structural empowerment, leadership-management performance, well-being, and quality of care
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2024 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1, article id 1491Article in journal (Refereed) Published
Abstract [en]

Background: Leadership and access to structural empowerment are known to influence the work life experiences of staff and quality of care. Knowledge about relationships between specific factors of structural empowerment, leadership and management, staff well-being and quality of care at both an individual and unit level is scarce.

Aim: To study the relationship between staff-rated access to empowering structures, leadership and management performance, well-being, and quality of care in hospital settings measured at the individual level and aggregated at the unit level.

Methods: A cross-sectional correlative design was applied. Questionnaire data from 331 randomized hospital nursing staff working at 38 units in 25 hospitals in Sweden were analyzed using bivariate correlations and general estimation equation (GEE) models.

Results: Results from the bivariate analysis of relationships confirmed earlier research. In the GEE models, some unexpected results were found and differences between the individual and unit levels. Adding management and leadership as independent factors in the second model showed few relationships of significance to the outcome variables.

Conclusion: Results confirm the importance of staff access to empowering structures in relation to well-being and quality of care. Differences and similarities were shown when studying these relationships at both the individual and unit level. The findings feature implications for hospital management to promote staff access to empowering structures. The findings provide information on how these structures relate to the individual and the unit; information that could be useful when planning or implementing strategies with the aim to promote staff well-being and care quality. The non-significant results for leadership and management in relation to staff outcomes in the GEE-models, raise questions for further research where a shift from individual to organizational focused performances within the field of leadership is implied.

Place, publisher, year, edition, pages
Springer, 2024
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-46159 (URN)10.1186/s12913-024-11945-6 (DOI)001366326500003 ()39604932 (PubMedID)2-s2.0-85211052100 (Scopus ID)
Available from: 2024-12-12 Created: 2024-12-12 Last updated: 2024-12-16Bibliographically approved
Projects
Arbetsmiljö och hälsa bland personal i äldreomsorgen: en modell för validering och lärande med stöd av IKT hos personal som saknar formell kompetens [100062]; University of GävleÄldreomsorgens vårdare och ledare; samspelet mellan strukturella förutsättningar, chef- ledarskap, arbetssituation och personalens hälsa [110043]; University of GävleThe Intervention CAN-Work-S: Facilitating Work Participation among Cancer Survivors During their Entire Professional Career [2021-01546_Forte]; University of Gävle
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9912-5350

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