Nilsson Kerstin, Hertting Anna, Petterson Inga-Lill, Theorell Töres
School of Life Sciences, University of Skövde, Skövde, Sweden.
BMC Public Health. 2005 Sep 1;5:92. doi: 10.1186/1471-2458-5-92.
This study focuses on determinants of a healthy work environment in two departments in a Swedish university hospital. The study is based on previously conducted longitudinal studies at the hospital (1994-2001), concerning working conditions and health outcomes among health care personnel in conjunction with downsizing processes. Overall, there was a general negative trend in relation to mental health, as well as long-term sick leave during the study period. The two departments chosen for the current study differed from the general hospital trend in that they showed stable health development. The aim of the study was to identify and analyse experiential determinants of healthy working conditions.
Thematic open-ended interviews were carried out with seventeen managers and key informants, representing different groups of co-workers in the two departments. The interviews were transcribed verbatim and an inductive content analysis was made.
In the two studied departments the respondents perceived that it was advantageous to belong to a small department, and to work in cooperation-oriented care. The management approaches described by both managers and co-workers could be interpreted as transformational, due to a strain of visionary, delegating, motivating, confirmative, supportive attitudes and a strongly expressed solution-oriented attitude. The daily work included integrated learning activities. The existing organisational conditions, approaches and attitudes promoted tendencies towards a work climate characterised by trust, team spirit and professionalism. In the description of the themes organisational conditions, approaches and climate, two core determinants, work-pride and confidence, for healthy working conditions were interpreted. Our core determinants augment the well-established concepts: manageability, comprehensiveness and meaningfulness. These favourable conditions seem to function as a buffer against the general negative effects of downsizing observed elsewhere in the hospital, and in the literature.
Research illuminating health-promoting aspects is rather unusual. This study could be seen as explorative. The themes and core dimensions we found could be used as a basis for further intervention studies in similar health-care settings. The result could also be used in future health promotion studies in larger populations. One of the first steps in such a strategy is to formulate relevant questions, and we consider that this study contributes to this.
本研究聚焦于瑞典一家大学医院两个科室健康工作环境的决定因素。该研究基于此前在该医院开展的纵向研究（1994 - 2001年），涉及医疗保健人员在医院精简过程中的工作条件和健康状况。总体而言，在研究期间，心理健康以及长期病假方面呈现出普遍的负面趋势。当前研究选取的两个科室与医院的总体趋势不同，它们展现出稳定的健康发展态势。本研究的目的是识别并分析健康工作条件的经验性决定因素。
对17名管理人员和关键信息提供者进行了主题开放式访谈，他们代表了两个科室不同的同事群体。访谈内容逐字记录，并进行了归纳性内容分析。
在两个被研究的科室中，受访者认为隶属于小科室以及从事以合作为导向的护理工作具有优势。管理人员和同事所描述的管理方式可被解读为变革型的，因为具有一系列富有远见、授权、激励、肯定、支持的态度以及强烈表达的以解决问题为导向的态度。日常工作包括综合学习活动。现有的组织条件、方式和态度促进了一种以信任、团队精神和专业精神为特征的工作氛围的形成。在对组织条件、方式和氛围这些主题的描述中，解读出了健康工作条件的两个核心决定因素，即工作自豪感和自信心。我们的核心决定因素丰富了已确立的概念：可管理性、全面性和意义性。这些有利条件似乎起到了缓冲作用，抵御了医院其他地方以及文献中所观察到的精简带来的普遍负面影响。
阐明促进健康方面的研究相当少见。本研究可被视为探索性的。我们发现的主题和核心维度可作为类似医疗保健环境中进一步干预研究的基础。研究结果也可用于未来更大规模人群的健康促进研究。这种策略的首要步骤之一是提出相关问题，我们认为本研究对此有所贡献。
