Willemse B M, Depla M F I A, Smit D, Pot A M
Netherlands Institute of Mental Health and Addiction, Program on Aging, P.O. Box 725, 3500 AS Utrecht, the Netherlands.
Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center , De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
Int Psychogeriatr. 2014 May;26(5):805-16. doi: 10.1017/S1041610214000015. Epub 2014 Feb 10.
Over the past few decades, new care models that are more resident-oriented and directed toward small-scale and homelike environments have been developed worldwide. The impact of these care models on the quality of life of residents has been studied. However, little research has been conducted to gain insight into how these new care models influence healthcare staff's work environment. This study focuses on the consequences of small-scale care on staff's perceived job characteristics.
Data were derived from a sample of 136 Dutch living arrangements providing nursing home care for people with dementia (2008/2009), in which 1,327 residents and 1,147 staff participated. The relationship between two indicators of small-scale care (small-scale care characteristics and total number of residents with dementia in facility) and staff's job characteristics (job demands, decision authority, coworker and supervisor support) were studied with multilevel regression analyses. All analyses were adjusted for staff, resident, and living arrangement characteristics when needed.
Both indicators of small-scale care were associated with job demands; staff perceived less time and work pressure as more characteristics of small-scale care were integrated and the facility had less residents with dementia in total. Only one indicator was associated with decision authority. As more characteristics of small-scale care were integrated, staff's perceived decision authority was higher. No relationship was found with coworker and supervisor social support.
Knowing that job demands and decision authority are important predictors of job appraisal and well-being, our findings show that small-scale care could have a beneficial impact on healthcare staff's work environment.
在过去几十年里，全球范围内开发了更以居民为导向、面向小规模且类似家庭环境的新型护理模式。这些护理模式对居民生活质量的影响已得到研究。然而，对于这些新型护理模式如何影响医护人员的工作环境，却鲜有研究。本研究聚焦于小规模护理对员工感知到的工作特征的影响。
数据来源于2008/2009年为痴呆症患者提供养老院护理的136个荷兰居住安排样本，其中1327名居民和1147名工作人员参与。通过多层次回归分析研究小规模护理的两个指标（小规模护理特征和设施中痴呆症居民总数）与员工工作特征（工作需求、决策权、同事和上级支持）之间的关系。所有分析在需要时均针对员工、居民和居住安排特征进行了调整。
小规模护理的两个指标均与工作需求相关；随着小规模护理的更多特征被整合且设施中痴呆症居民总数减少，员工感知到的时间和工作压力更小。只有一个指标与决策权相关。随着小规模护理的更多特征被整合，员工感知到的决策权更高。未发现与同事和上级社会支持存在关联。
鉴于工作需求和决策权是工作评价和幸福感的重要预测因素，我们的研究结果表明小规模护理可能对医护人员的工作环境产生有益影响。
