Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital
Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital
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DOI：
10.1136/oem.2004.018069
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发表时间：
2006-05-01
影响因子：
4.9
通讯作者：
Lower, A
中科院分区：
文献类型：
--
作者：
Bourbonnais, R;Brisson, C;Lower, A
目的：描述的参与性干预的发展和实施阶段，旨在减少四个理论基础和经验支持的不利心理社会工作的因素（高心理需求，低决策纬度，低社会支持，低奖励），和他们的心理健康effects.Methods：干预实现了500护理提供者在急性护理医院。事先进行风险评估，使用定量方法，以确定不良心理社会工作因素和心理困扰的患病率在医院相比，适当的参考人群。此外，定性的方法包括观察在护理单位，采访了关键的线人，并与干预团队（IT），包括所有的利益相关者的协作工作。结果：事先的风险评估显示，高患病率的不良心理社会因素和心理困扰的护理人员相比，一个有代表性的样本工人从一般人群。在先前的风险评估中，与心理困扰相关的工作心理社会变量是高心理需求（患病率（PR）= 2.27），来自主管和同事的低社会支持（PR = 1.35），低回报（PR = 2.92）和努力-回报失衡（PR = 2.65）。这些结果表明，在护理提供者之间的四个选定的不良心理社会因素的干预的经验相关性。定性方法允许确定56不利条件及其解决方案。干预目标与团队合作和团队精神，人员配置过程，工作组织，培训，沟通，和ergonomy.Conclusion：这项研究增加了稀缺的文献描述的发展和实施预防性干预，旨在减少心理社会因素在工作和健康的影响。即使不利条件的心理社会环境和解决方案，在这项研究中确定的可能是特定的医疗保健部门，使用的干预过程（参与式解决问题）似乎高度出口到其他工作组织。
Objectives: To describe the development and implementation phases of a participative intervention aimed at reducing four theory grounded and empirically supported adverse psychosocial work factors (high psychological demands, low decision latitude, low social support, and low reward), and their mental health effects.Methods: The intervention was realised among 500 care providers in an acute care hospital. A prior risk evaluation was performed, using a quantitative approach, to determine the prevalence of adverse psychosocial work factors and of psychological distress in the hospital compared to an appropriate reference population. In addition, a qualitative approach included observation in the care units, interviews with key informants, and collaborative work with an intervention team (IT) including all stakeholders.Results: The prior risk evaluation showed a high prevalence of adverse psychosocial factors and psychological distress among care providers compared to a representative sample of workers from the general population. Psychosocial variables at work associated with psychological distress in the prior risk evaluation were high psychological demands (prevalence ratio (PR) = 2.27), low social support from supervisors and co-workers (PR = 1.35), low reward (PR = 2.92), and effort-reward imbalance (PR = 2.65). These results showed the empirical relevance of an intervention on the four selected adverse psychosocial factors among care providers. Qualitative methods permitted the identification of 56 adverse conditions and of their solutions. Targets of intervention were related to team work and team spirit, staffing processes, work organisation, training, communication, and ergonomy.Conclusion: This study adds to the scarce literature describing the development and implementation of preventive intervention aimed at reducing psychosocial factors at work and their health effects. Even if adverse conditions in the psychosocial environment and solutions identified in this study may be specific to the healthcare sector, the intervention process used (participative problem solving) appears highly exportable to other work organisations.