Workplace Participatory Occupational Health/Health Promotion Program: Facilitators and Barriers Observed in Three Nursing Homes

Nursing home employees experience high physical and psychosocial workloads, resulting in poor health outcomes. An occupational health/health promotion program, designed to facilitate employee participation, was initiated in three nursing homes. The aim of the current study was to evaluate facilitators and barriers of the program after 3-year implementation. Focus groups with employees and in-depth interviews with top and middle managers were conducted. The Social Ecological Model was used to organize the evaluation. Facilitators and barriers were reported from both managers' and employees' perspectives, and were categorized as intrapersonal, interpersonal, institutional, and corporate level. Management support, financial resources, and release time for participation were identified as the three most important factors. Supports from multiple levels including both human and environment, and managers and employees, are important for a successful participatory occupational health/health promotion program. [Journal of Gerontological Nursing, 42(6), 34-42.].

Assessing Organizational Readiness for a Participatory Occupational Health/Health Promotion Intervention in Skilled Nursing Facilities

The long-term care sector is characterized by high morbidity and employee turnover, along with associated costs. Effective health protection and health promotion are important to improve physical and psychosocial well-being of caregivers. Assessment of organizational readiness for change is an essential precursor to the successful implementation of workplace programs addressing work climate, structure of tasks and relationships, and other issues that may be perceived as challenging by some within the institution. This study qualitatively assessed readiness of five skilled nursing facilities for a participatory occupational health/health promotion intervention. Selection criteria were developed to screen for program feasibility and ability to conduct prospective evaluations, and information was collected from managers and employees (interviews and focus groups). Three centers were selected for the program, and the first year of formative evaluation and intervention experience was then reviewed to evaluate and modify our selection criteria after the fact. Lessons learned include adding assessment of communication and the structure of problem solving to our selection criteria, improving methods to assess management support in a concrete (potentially nonverbal) form, and obtaining a stated financial commitment and resources to enable the team to function. Assessment of organizational readiness for change is challenging, although necessary to implement effective and sustainable health promotion programs in specific organizations.

Nursing assistants' dilemma: caregiver versus caretaker

Focus groups were conducted with over 150 certified nursing assistants (CNAs) in seven nursing homes to obtain their opinions on how the work environment supported or impeded their caregiving to residents. Strong opinions emerged about work environment interference with CNAs' ability to provide quality and comprehensive care. Participants also believed that their supervisors did not respect the value of the care and nurturing that CNAs provided. This contrasted with the respect that CNAs voiced for residents. The findings highlight the need for improved relationships between CNAs and management and suggest some desirable features of work organization in nursing homes.

Work organization and health issues in long-term care centers

This qualitative study explored common and divergent perceptions of caregivers and managers regarding occupational health and safety, work organization, and psychosocial concerns in long-term care centers. Both common and differing issues were identified. Both groups agreed on the importance of ergonomic concerns, the high prevalence of stress, and receptiveness to participatory health promotion programs. However, numerous work organization issues and physical and psychosocial workplace hazards were identified by certified nursing assistants but were not mentioned by managers. The results suggest that different perceptions naturally arise from people's varying positions in the occupational hierarchy and their consequent exposures to health and safety hazards. Improved systems of communication that allow frontline workers to express their concerns would make it possible to create solutions to these problems.

A review of employment conditions as social determinants of health part II: the workplace

This is the second part of an article on employment conditions as social determinants of health and health inequalities. In part I of this article, we explored structural (external) employment conditions that affect health inequalities and health gradients. In this article, we try to examine the internal aspects of employment conditions that affect the same variables. It is not our intention to "box" employment conditions in a rigid framework within an internal domain of person-hazard interaction. The objective of examining this variable is to scrutinize internal aspects of employment conditions at a comprehensive policy level in conjunction with external contextual variables. Major occupational health concerns are examined in relationship to globalization, child labor, and work in the formal and informal sectors. Interventions that can eliminate or greatly reduce these exposures as well as those that have been unsuccessful are reviewed. Innovative interventions including work organization change, cleaner production, control banding, national and international coalitions, participatory training, and participatory approaches to improving the work environment are reviewed.