Evidence-based Workplace Research Articles

Promoting resilience in mental health nurses: A partially clustered randomised controlled trial

BackgroundThere is a critical global shortage of nurses in mental health, with workforce attrition due in large part to workplace stressors. Proactive strengths-based interventions to strengthen nurses' capacity to manage stress and improve mental health, wellbeing and resilience may also support workforce retention. ObjectiveTo determine the effects of a resilience-building programme on mental health nurses' coping self-efficacy (primary outcome), and psychological distress, wellbeing, resilience, posttraumatic growth, emotional intelligence behaviours, workplace belonging, and turnover intention (secondary outcomes). DesignPartially clustered randomised controlled trial. SettingLarge tertiary metropolitan mental health service in Australia. ParticipantsA total of 144 registered and enrolled nurses working clinically ≥0.6 full-time equivalent (73/intervention, 71/control), with 122 completing 3-month follow-up. MethodsThe Promoting Resilience in Nurses programme is an evidence-based workplace intervention delivered by trained facilitators across two workshops. Surveys were administered online upon registration and prior to randomisation (Time 1) into Intervention or Control (no intervention) arms, and immediately after the final workshop (Time 2), and at three months follow-up (Time 3). Linear mixed models for outcome measures were fitted to Time 2 and 3 responses. ResultsThere were seven intervention groups, with seven to 13 participants per group. Coping self-efficacy improved at Time 2 (estimated intervention effect 21.2 units, 95 % Confidence Intervals: 13.3 to 29.0) and Time 3 (12.1 units, 4.7 to 19.6), as well as wellbeing (Time 2: 9.2 units, 5.0 to 13.4), resilience (Time 2: 0.24 units, 0.01 to 0.46) and posttraumatic growth (Time 2: 16.1 units, 7.0 to 25.3). Psychological distress reduced (Time 2: −3.7 units, −6.2 to −1.31). All were sustained at three months. Emotional intelligence behaviours were improved (Time 2: 3.5 units, 0.6 to 6.5) but not sustained. Workplace belonging improved at Time 3 (0.34 units, 0.02 to 0.65) only. No statistically significant effects for turnover intention. ConclusionsDespite major contextual challenges, the Promoting Resilience in Nurses programme achieved the aims of promoting nurses' efficacy to cope with stress and regulate their emotions and improving mental health and wellbeing. The findings support the programme as a feasible and successful intervention for nurses across other settings and contexts. Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12620001052921). Registered 15/10/2020. First recruitment 04/02/2021. Tweetable abstractPromoting Resilience in Nurses intervention improved coping self-efficacy, wellbeing, resilience, posttraumatic growth, emotional intelligence and psychological distress.

Work-related suicide: Evolving understandings of etiology & intervention.

Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10%-13% of suicide deaths. Yet, the way in which work may increase suicide risk is an underdeveloped area of epidemiologic research. In this Commentary, we propose a definition of work-related suicide from an occupational health and safety perspective, and review the case investigation-based and epidemiologic evidence on work-related causes of suicide. We identified six broad categories of potential work-related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high-stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work-related injury or illness. We summarise current evidence in a schema of potential work-related causes that can also be applied in workplace risk assessment and suicide case investigations. There are numerous implications of these findings for policy and practice. Various principle- and evidence-based workplace intervention strategies for suicide prevention exist, some of which have been shown to improve suicide-prevention literacy, reduce stigma, enhance helping behaviours, and in some instances maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasises individual- and illness-directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential.

Implementing Evidence-Based Workplace Violence Prevention Education to Support Frontline Staff at Risk for Workplace Violence.

Prior studies assessing workplace violence educational interventions have found positive outcomes including increased frontline staff confidence and reduced restraint utilization. An electronic, evidenced-based educational module was provided to frontline staff across a large healthcare system in response to a gap found during analysis of workplace violence prevention initiatives. This quality improvement project found that education can be feasibly implemented across large healthcare organizations to improve frontline staff vigilance and awareness of workplace violence risks.

Experiences in the application of logic models in the context of workplace health promotion – A focus group discussion

Gathering evidence on complex workplace health promotion interventions faces methodological challenges. Therefore, the application of logic models as a theory of change is recommended to support outcome and process evaluations. The present study explores challenges and opportunities of applying logic models in application-oriented intervention research on workplace health promotion. A focus group (n = 6), consisting of scientists and workplace health promotion practitioners, was conducted using a semi-structured interview guide. The recorded qualitative data were transcribed and analysed using the structuring content analysis method. According to the focus group, logic models provide several opportunities for planning and evaluating complex workplace health promotion interventions. Logic models support the communication between science and practice, and have benefits for the provider of workplace health promotion interventions. The main challenges in working with logic models were dealing with the complex and constantly developing intervention and with the derivation and implementation of reasonable evaluation methods. The focus group exposed repeated application and a shared understanding between stakeholders as facilitators for working with logic models. In conclusion, at the science-practice interface, logic models could enhance the integrative understanding and the further development of evidence-based workplace health promotion.

Chronic Obstructive Pulmonary Disease and Work: The Continuing Narrative

It has long been recognized that harmful inhaled workplace exposures can contribute to the development of chronic obstructive pulmonary disease (COPD). This article, intended for the clinician, summarizes some of this evidence and some areas of controversy. Current estimates based on pooled epidemiological analyses of population-based studies identify that approximately 14% of the burden of COPD (and 13% of the burden of chronic bronchitis) is attributable to such exposures. In addition to these approaches, various studies implicate specific exposures as contributing. Certain of these relating to cadmium, coal, and respirable crystalline silica are discussed in more detail. Despite this amassed evidence to date supporting associations between COPD and workplace exposures, there have been surprisingly few studies that have attempted to assess the attribution by experts of an occupational cause in cases of COPD. One study, using hypothetical cases of COPD, noted that while expert physicians were willing to make such an occupational link, this was only likely in cases with light smoking histories and a priori defined heavy occupational exposures. Relatively recent data relating to computed tomography (CT) scan appearances may give the clinician a further guide. Several studies from populations have now linked potentially harmful occupational exposures specifically with the presence of emphysema on CT scanning. It will be of interest to see if this finding, along with other clinical attributes of cases such as smoking and family histories, exclusion of asthma, genetic data, and the nature of workplace exposures, will increase the future diagnosis by clinicians of occupational COPD. In the interim, while better diagnostic approaches are developed, we suggest that consideration of an occupational cause is an important part of the clinical investigation of cases of COPD. Finally, we suggest that evidence-based workplace preventive strategies for occupational COPD should be informed by knowledge of which exposures are most important to reduce, and whether and when intervention to reduce exposure at an individual worker level is warranted.

Functions and relevance of spatial co-presence: Lessons learned from the COVID-19 pandemic for evidence-based workplace and human capital management

Introduction: This study aims to analyze the role of co-presence against the background of COVID-19 pandemic to derive implications for an interdisciplinary, evidence-based workplace and human capital management. A theoretical framework is outlined that considers a range of topics from task performance to social and organizational contextual factors.Methods: In a single organization qualitative case study, five focus group interviews including a total of 20 employees of an IT consultancy were conducted to identify the effects of the mandatory remote working regimes imposed by the COVID-19 Pandemic on task and contextual performance.Results: Findings show that individual performance was assessed to have increased while internal processes remained at similar levels compared to pre-pandemic levels. Organizational culture, social contact, and identity, however, were reported to have considerably deteriorated in the view of the participants.Discussion: The study shows that for a company that was very experienced with distributed working, the reduction of co-presence had important effects on performance and culture. Findings suggest that co-presence must be carefully managed in the future. This could become a new joint priority for workplace design, workplace management, and human capital management.

Assessment of Virtual Mindfulness-Based Training for Health Care Professionals: Improved Self-Reported Respiration Rates, Perceived Stress, and Resilience.

Mindfulness in Motion (MIM) is a workplace resilience-building intervention that has shown reductions in perceived stress and burnout, as well as increased resilience and work engagement in health care workers. To evaluate effects of MIM delivered in a synchronous virtual format on self-reported respiratory rates (RR), as well as perceived stress and resiliency of health care workers. Breath counts were self-reported by 275 participants before and after 8 weekly MIM sessions. MIM was delivered virtually in a group format as a structured, evidence-based workplace intervention including a variety of mindfulness, relaxation, and resilience-building techniques. Participants counted their breaths for 30seconds, which was then multiplied by 2 to report RR. Additionally, participants completed Perceived Stress Scale and Connor-Davidson Resiliency Scale. According to mixed effect analyses there were main effects of MIM Session (P < .001) and Weeks (P < .001), but no Session by Week interaction (P = .489) on RR. On average, RR prior to MIM sessions were reduced from 13.24bpm (95% CI = 12.94, 13.55bpm) to 9.69bpm (95% CI = 9.39, 9.99bpm). When comparing average Pre-MIM and Post-MIM RR throughout the MIM intervention, Week-2 (mean = 12.34; 95% CI = 11.89, 12.79bpm) was not significantly different than Week-1 (mean = 12.78; 95% CI = 12.34, 13.23bpm), but Week-3 through Week-8 demonstrated significantly lower average Pre-MIM and Post-MIM RR compared to Week-1 (average weekly difference range: 1.36 to 2.48bpm, P < .05). Perceived stress was reduced from Week-1 (17.52 ± 6.25) to after Week-8 (13.52 ± 6.04; P < .001), while perceived resiliency was increased from Week-1 (11.30 ± 5.14) to after Week-8 (19.29 ± 2.58); P < .001). Thus far, completion of MIM sessions has shown acute and long-term effects on self-reported RR, but more research is required to determine the extent of improved parasympathetic (relaxed) states. Collectively, this work has shown value for mind-body stress mitigation and resiliency-building in high stress acute health care environments.

A team level participatory approach aimed at improving sustainable employability of long-term care workers: a study protocol of a randomised controlled trial

BackgroundStaff currently working in long-term care experience several difficulties. Shortage of staff and poor working conditions are amongst the most prominent, which pose a threat to staff’s sustainable employability. To improve their sustainable employability it is important to create working conditions that fulfil workers’ basic psychological need for autonomy, relatedness and competence in line with Self-Determination Theory. Since many long-term care organisations work with self-managing teams, challenges exist at team level. Therefore, there is a need to implement an intervention aimed at maintaining and improving the sustainable employability of staff on team level.MethodsWe developed a participatory workplace intervention, the Healthy Working Approach. In this intervention teams will uncover what problems they face related to autonomy, relatedness and competence in their team, come up with solutions for those problems and evaluate the effects of these solutions. We will evaluate this intervention by means of a two-arm randomized controlled trial with a follow-up of one year. One arm includes the intervention group and one includes the waitlist control group, each consisting of about 100 participants. The primary outcome is need for recovery as proxy for sustainable employability. Intervention effects will be analysed by linear mixed model analyses. A process evaluation with key figures will provide insight into barriers and facilitators of the intervention implementation. The Ethical Committee Social Sciences of the Radboud University approved the study.DiscussionThis study will provide insight in both the effectiveness, and the barriers/facilitators of the implementation process of the Healthy Working Approach. The approach is co-created with long-term care workers, focuses on team-specific challenges, and is rooted in the evidence-based participatory workplace approach and Self-Determination Theory. First results are expected in 2022.Trial registrationNetherlands Trial Register, NL9627. Registered 29 July 2021 - Retrospectively registered.

Occupational Health, Productivity and Evidence-Based Workplace Health Intervention

Occupational Health, Productivity and Evidence-Based Workplace Health Intervention

Development of a behaviour change workplace-based intervention to improve nurses\u2019 eating and physical activity

BackgroundThere is a critical need for an intervention to improve nurses’ eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses.MethodsThe intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities: (1) identifying the evidence base, (2) understanding the determinants of nurses’ eating and physical activity behaviour change through theory-based qualitative interviews and survey, (3) identifying intervention options using the Behaviour Change Wheel, and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques.ResultsData from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses’ beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses, and key determinants included environmental context and resources, behavioural regulation, emotion, beliefs about consequences, knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention.ConclusionsAn evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses’ eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

Architectural Interventions to Mitigate Occupational Stress Among Office Workers

Stress is one issue that affects the health and well-being of every building occupant. The negative effects of stress are more pronounced in workplaces, where stress can act as a major agent of disease and an impediment to employee productivity and satisfaction. The underlying causes of occupational stress are varied and include job insecurity, extended hours, excessive workload, altercations within the organization, tight deadlines, changes in responsibilities, and lack of autonomy, among others. One of the factors that can contribute to overall occupational stress is the working environment itself—a factor that can be mitigated by design. While occupational stress may arise from a multiplicity of causes, designers have numerous interventions they can employ to decrease it.&#x0D; The literature on occupational health, well-being, satisfaction, and productivity is broad and multifaceted; however, this paper is limited to exploring stress factors that correlate with the built environment and focuses on employees who are experiencing a high rate of stress in office buildings as the target group. To address these issues, supporting literature was explored to identify environmental interventions that could reduce stress or enhance the stress-coping abilities of workers in offices by improving the environmental quality of the built environment.&#x0D; This article explores the following questions: How does space cause people to experience mental stress? In what ways can the built environment itself be a generator of stress? What are the main environmental factors in offices that can mitigate the stress levels of employees or help them to recover more easily from work-related stress? To answer these questions, it is necessary to understand the causes and mechanisms of chronic stress, including work-related stressors, and to identify the factors in the built environment that can be associated with occupational stress. The present paper is based on concurrent analyses of supporting literature in the rather different fields of architecture, public health, psychology, management, and environmental studies. The outcome is an identified set of practical strategies that provide solutions for healthier and more productive workplaces. By concentrating on measures that can reduce employee stress levels, these strategies can be used as a source for evidence-based workplace designs.

Updates on NORA Musculoskeletal Health Cross-Sector Council Activities

The National Occupational Research Agenda (NORA) is a research framework for the nation and for the National Institute for Occupational Safety and Health (NIOSH). The NORA Musculoskeletal Health Cross-Sector (MUS) Council focuses on the mitigation of work-related musculoskeletal disorders (WMSDs). Two projects have been chosen by the MUS Council for disseminating existing information on ergonomic assessment methods and interventions. The first project involves collaboration with the AIHA Ergonomics Committee on the latest update of the AIHA Ergonomic Assessment Toolkit. The second project aims to post all-industry information on ergonomic solutions/interventions/guidelines in collaboration with the International Ergonomics Association (IEA). The MUS Council plans on leveraging the collaborative efforts for promoting widespread adoption of evidence-based workplace practices for the prevention of WMSDs.

Relationship Between Sedentary Behavior and Physical Activity at Work and Cognition and Mood.

Sedentary behavior is negatively associated with cognition and mood. Adults often engage in high levels of sedentary behavior at work through sitting, which may impact productivity. Consequently, replacing sitting with standing and physical activity (PA) is recommended. However, the associations between sitting, standing, and PA at work and cognition and mood are unknown; this study, therefore, aimed to explore these relationships. A total of 75 healthy full-time workers (33 male, mean [SD]; 33.6 [10.4]y, 38 [7]work hr/wk) wore sedentary behavior (activPAL) and PA (SenseWear Pro) monitors for 7 days and recorded their work hours. The day after this monitoring period, participants completed cognitive tests (executive function, attention, and working memory) and mood questionnaires (affect, alert, content, and calm). Multiple linear regression analyses examined the associations between cognition and mood and the time spent sitting, standing, and in each PA intensity during work hours, weekday leisure time, and weekends. Workplace sitting, standing, or PA were not significantly associated with cognition or mood (P > .05). No significant associations were observed between these variables during weekday leisure time or weekends (P > .05). In a cohort of healthy workers, workplace sitting, standing, and PA are not associated with cognition or mood. Further research in this population is needed, examining the influence of workplace behaviors on cognition and mood, because this will contribute to evidence-based workplace guidelines to increase productivity.

Transition experiences of internationally qualified midwives practising midwifery in Australia

BackgroundInternationally qualified midwives comprise approximately 13% of the Australian midwifery workforce. Despite their central role in the Australian midwifery system, understanding of their transitional experiences is limited. AimTo explore the transitional experiences of internationally qualified midwives practising in Australia. MethodA descriptive qualitative study was undertaken, as the second phase of a larger mixed methods study. In this paper we present in-depth insights from 11 internationally qualified midwives practising in Australia. Individual semi-structured interviews were conducted between May–August 2018, digitally recorded and then transcribed. Transcriptions were analysed using a thematic analysis approach. FindingsParticipants in this study identified that the different culture of the work environment, differences in midwifery practice, lack of autonomy in their practice and perceived discrimination influenced their transition into Australian midwifery practice. Four themes were identified: ‘Differences in midwifery practice’, ‘Cultural incongruence’, ‘Discrimination’ and ‘Mixed emotions’. DiscussionSuccess during the complex transition process depends on the migrant midwives’ ability to build a sense of belonging, and to develop and adopt strategies that assist in dealing with new workplaces and an unfamiliar workforce. ConclusionA structured transition program prior to commencing practice, as well as an evidence-based workplace mentorship program with a focus on Australian midwifery care and culture, may be effective strategies to facilitate their transition. To promote awareness of multiculturalism within the work environment, this study recommends actively encouraging host staff to further develop perspectives that enable them to create positive relationships with staff from other cultures.

Striving for Social Good Through Organizational Inclusion: A Latent Profile Approach

Purpose:Promoting social good in the context of diverse organizations inevitably involves creating inclusive work environments wherein all members feel valued and appreciated for who they are. However, limited empirical work has uncovered evidence-based tools that can help organizational leaders strive for more inclusive organizations.Method:The current study used latent profile analysis as an empirical tool to provide a more in-depth understanding of workplace inclusion. Data were collected from a diverse nonprofit organization with 213 employees.Results:Findings suggested two latent profiles or subgroups of employees (those who felt less valued and those who felt more valued) who shared similar personal characteristics.Discussion:This information can be used to develop culturally sensitive and inclusive evidence-based workplace interventions that achieve social good by ensuring everyone in the organization feels valued. Implications are discussed for expanding macrolevel social work practice for professionals interested in promoting social good in diverse organizations.

Workplace design for the Australian residential aged care workforce.

This research explored residential aged care (RAC) workplace design features that influence how RAC staff feel valued, productive, safe, like they belong and connected. A secondary aim was to validate emerging themes about RAC design features with stakeholders. A multistage qualitative study was conducted in one RAC facility with 100 residents in outer metropolitan Melbourne: (i) photo-elicitation - photographs were used to prompt discussions with RAC staff; (ii) individual interviews with RAC directors; and (iii) validity testing with the advisory committee occurred. Key workplace design features that influenced how RAC staff feel valued, productive, safe, like they belong and connected included the following: (i) home-like environment; (ii) access to outdoor spaces; (iii) quality indoor environment; and (iv) access to safe, open and comfortable workplaces. Key workplace design features that matter to RAC staff in a 'shared workspace' exist. Increasing demands upon RAC requires evidence-based workplace design policy and evaluation approaches that support RAC staff to work in RAC shared workspaces.

Designing equitable workplace dietary interventions: perceptions of intervention deliverers

BackgroundWorkplaces are a good setting for interventions that aim to support workers in achieving a healthier diet and body weight. However, little is known about the factors that impact on the feasibility and implementation of these interventions, and how these might vary by type of workplace and type of worker. The aim of this study was to explore the views of those involved in commissioning and delivering the Better Health at Work Award, an established and evidence-based workplace health improvement programme.MethodsOne-to-one semi-structured interviews were conducted with 11 individuals in North East England who had some level of responsibility for delivering workplace dietary interventions. Interviews were transcribed verbatim and analysed using thematic framework analysis.ResultsA number of factors were felt to promote the feasibility and implementation of interventions. These included interventions that were cost-neutral (to employee and employer), unstructured, involved colleagues for support, took place at lunchtimes, and were well-advertised and communicated via a variety of media. Offering incentives, not necessarily monetary, was perceived to increase recruitment rates. Factors that militate against feasibility and implementation of interventions included worksites that were large in size and remote, working patterns including shifts and working outside of normal working hours that were not conducive to workers being able to access intervention sessions, workplaces without appropriate provision for healthy food on site, and a lack of support from management.ConclusionsIntervention deliverers perceived that workplace dietary interventions should be equally and easily accessible (in terms of cost and timing of sessions) for all staff, regardless of their job role. Additional effort should be taken to ensure those staff working outside normal working hours, and those working off-site, can easily engage with any intervention, to avoid the risk of intervention-generated inequalities (IGIs).

Insights into workplace bullying: psychosocial drivers and effective interventions

Research on effectiveness of workplace bullying interventions has lagged behind descriptive studies on this topic. The literature on bullying intervention research has only recently expanded to a point that allows for synthesis of findings across empirical studies. This study addresses the question of whether workplace bullying can be reduced in prevalence and consequences, if so to what extent and by which strategies and interventions. It opens with a brief overview of the nature of bullying at work and discussion of some precursors and existing interventions. However, its principal focus is on the findings obtained from selected (quasi-) experimental longitudinal studies on antibullying interventions, drawing together the results of studies conducted in Europe, USA, and Australia, including several economic sectors, and concerned about primary, secondary, and tertiary prevention programs and strategies. Additional emphasis is considered from the psychosocial drivers highlighted both from prescriptive and cross-sectional studies and factual empirical studies. One randomized control study and seven quasiexperimental longitudinal studies were identified by searching electronic databases and bibliographies and via contact with experts. The majority of outcomes evidenced some level of change, mostly positive, suggesting that workplace bullying interventions are more likely to affect knowledge, attitudes, and self-perceptions, but actual bullying behaviors showed much more mixed results. In general, growing effectiveness was stated as the level of intervention increased from primary to tertiary prevention. However, methodological problems relating to the evaluation designs in most studies do not allow direct attribution of these findings to the interventions. Overall, the evaluation of antibullying interventions must flourish and be improved, requiring close cooperation between practitioners and academics to design, implement, and evaluate effective interventions based on grounded theoretical and methodological approaches. Finally, this systematic review highlights future directions for enhancing the adoption, high-quality implementation, and dissemination of evidence-based workplace bullying prevention and intervention programs.

Variability and Limits of US State Laws Regulating Workplace Wellness Programs.

We examined variability in state laws related to workplace wellness programs for public and private employers. We conducted legal research using LexisNexis and Westlaw to create a master list of US state laws that existed in 2014 dedicated to workplace wellness programs. The master list was then divided into laws focusing on public employers and private employers. We created 2 codebooks to describe the variables used to examine the laws. Coders used LawAtlas(SM) Workbench to code the laws related to workplace wellness programs. Thirty-two states and the District of Columbia had laws related to workplace wellness programs in 2014. Sixteen states and the District of Columbia had laws dedicated to public employers, and 16 states had laws dedicated to private employers. Nine states and the District of Columbia had laws that did not specify employer type. State laws varied greatly in their methods of encouraging or shaping wellness program requirements. Few states have comprehensive requirements or incentives to support evidence-based workplace wellness programs.

Active Barrier Apparel: The Simple, Evidence-Based Workplace and Patient Safety Strategy

Active Barrier Apparel: The Simple, Evidence-Based Workplace and Patient Safety Strategy