Czuba Karol J, Vandal Alain C, Czuba Frances M, Kayes Nicola M
Centre for Person Centred Research, Auckland University of Technology, Northcote, Auckland 0627, New Zealand.
Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
Int J Nurs Stud Adv. 2023 Oct 15;5:100158. doi: 10.1016/j.ijnsa.2023.100158. eCollection 2023 Dec.
Support workers are central to the delivery of residential aged care, but the workforce is facing increasing work demands and widespread shortages. This contributes to high rates of burnout, decreased job satisfaction and high staff turnover. Peer-led interventions are reported to be effective but it is necessary to use evidence-based interventions to support this key workforce group.
This study aimed to evaluate the scientific evidence on effectiveness of strategies improving psychosocial and turnover-related outcomes for support workers in aged care that could be incorporated into a peer-led intervention.
Systematic review and meta-analyses of experimental and quasi-experimental studies.
Residential aged care.
A systematic literature review was conducted using MEDLINE (via PubMed), EMBASE (via Scopus), and CINAHL (via EBSCO). We included studies examining the effectiveness of workplace interventions aiming to reduce aged care support workers' turnover rates and/or improve their work-related psychosocial outcomes (such as work stress, job satisfaction, self-esteem, and other). A number of meta-analyses using a mixed-effects model were performed to calculate standardized mean differences and odds ratios.
Fifty-one studies were included: 15 randomised controlled trials (RCTs), 19 non-RCTs and 17 Pre-Post studies. Most of the studies were rated as having 'high' or 'very high risk of bias'. The studies were clustered by intervention type: 1) knowledge-based, 2) interpersonal skills-based, 3) team-building, and 4) self-care. Knowledge-based interventions were the most used approach, with 26 studies in this category, and frequently reported improvements in stress- and satisfaction-related outcomes. There were twelve interpersonal skills-based and nine team-building interventions, which often reported decreased work stress, staff turnover, and intention to quit. There were four self-care interventions of which only one reported improvements in stress-related outcomes. Meta-analyses showed that only knowledge-based interventions resulted in statistically significant improvements: lower staff turnover rates (OR 0.47, 95 %CI: 0.37, 060), and higher scores for job/life satisfaction (SMD 0.26, 95 % CI: 0.05, 0.46) and staff attitude (SMD 0.23, 95 % CI: 0.05, 0.45).
This review found numerous strategies that have been trialled to improve support workers' psychosocial- and turnover-related outcomes. Most studies reported improvements in outcomes. However, our meta-analyses suggest that the effect sizes were small and mostly non-significant, with the evidence being of low certainty. The evidence for effectiveness of knowledge-based interventions appears the most convincing, with statistically significant improvements reported for turnover rates, job/life satisfaction and staff attitude. More high-quality studies are needed to consolidate the existing evidence.
CRD42017059007; 02 June 2017.Tweetable abstract: Knowledge-based interventions most promising in improving support workers' outcomes in aged care. #agedcare #staffturnover.
护工是提供住宿型老年护理服务的核心力量，但该劳动力群体正面临日益增加的工作需求和普遍的人员短缺问题。这导致了职业倦怠率高、工作满意度下降和员工流动率高。据报道，同伴主导的干预措施是有效的，但有必要采用基于证据的干预措施来支持这一关键劳动力群体。
本研究旨在评估改善老年护理护工心理社会和与离职相关结果的策略有效性的科学证据，这些策略可纳入同伴主导的干预措施。
对实验性和准实验性研究进行系统评价和荟萃分析。
住宿型老年护理机构。
使用MEDLINE（通过PubMed）、EMBASE（通过Scopus）和CINAHL（通过EBSCO）进行系统的文献综述。我们纳入了研究旨在降低老年护理护工离职率和/或改善其与工作相关的心理社会结果（如工作压力、工作满意度、自尊等）的工作场所干预措施有效性的研究。使用混合效应模型进行了多项荟萃分析，以计算标准化平均差和比值比。
纳入了51项研究：15项随机对照试验（RCT）、19项非随机对照试验和17项前后对照研究。大多数研究被评为具有“高”或“非常高的偏倚风险”。这些研究按干预类型进行聚类：1）基于知识的，2）基于人际技能的，3）团队建设的，4）自我护理的。基于知识的干预措施是最常用的方法，此类有26项研究，并且经常报告与压力和满意度相关的结果有所改善。有12项基于人际技能的干预措施和9项团队建设干预措施，这些措施经常报告工作压力、员工流动率和离职意愿有所降低。有4项自我护理干预措施，其中只有1项报告与压力相关的结果有所改善。荟萃分析表明，只有基于知识的干预措施产生了统计学上显著的改善：较低的员工流动率（OR 0.47，95%CI：0.37，0.60），以及更高的工作/生活满意度得分（SMD 0.26，95%CI：0.05，0.46）和员工态度得分（SMD 0.23，95%CI：0.05，0.45）。
本综述发现了许多已试验过的改善护工心理社会和与离职相关结果的策略。大多数研究报告结果有所改善。然而，我们的荟萃分析表明，效应量较小且大多不显著，证据的确定性较低。基于知识的干预措施有效性的证据似乎最有说服力，报告显示在流动率、工作/生活满意度和员工态度方面有统计学上显著的改善。需要更多高质量的研究来巩固现有证据。
PROSPERO注册号：CRD42017059007；2017年6月2日。可发推文的摘要：基于知识的干预措施在改善老年护理护工结果方面最有前景。#老年护理#员工流动率
