Working Relationships Research Articles

Normal reference of myocardial work during exercise stress echocardiography and the doubt about wasted work

Abstract Aims Myocardial work (MW) estimated based on pressure-strain loops is a noninvasive parameter for evaluating left ventricular function. The aims of this study were (1) to characterize the MW changes at rest and post-exercise in healthy adults and heart failure with preserved ejection fraction (HFpEF) patients, (2) to explore the related influencing factors for the increase of global wasted work (GWW) after exercise. Methods and results The study enrolled 167 healthy adults and 38 HFpEF patients. All subjects underwent comprehensive echocardiographic assessment at rest and immediately after a symptom-limited treadmill stress test. The MW changes and the impact of sex were analyzed. The related influencing factors for the increase of GWW after exercise were explored. Global work efficiency (GWE) was decreased and other global parameters were increased after exercise in normal adults. There was no significant difference of all global parameters between sexes at rest. GWE was higher in men after exercise (p<0.05).There was no significant difference in MW reserve parameters between sexes. Peak positive strain (PPS) significantly increased after exercise, while GWE reduced in normal adults and HFpEF patients (p<0.05). PPS was independently associated with GWW in normal adults and patients with HFpEF both at rest and after exercise (normal adults: r: 0.77, p<0.001 at rest, r: 0.72, p<0.001 after exercise; HFpEF patients: r: 0.74, p<0.001 at rest, r: 0.62, p<0.001 after exercise). Conclusion Global MW parameters were less affected by sex. PPS was independently associated with GWW in normal adults and patients with HFpEF and the work done due to myocardial elongation might not be calculated as wasted work during the isovolumic contraction phase.example of myocardial work and PPSThe relationship between PPS and GWW

Sabbath, Contemplative Time, and Liturgical Listening

As we explore listening practices in global Catholicism, we have an opportunity to learn from spiritual traditions and their wisdom about stillness, receptivity, rest, and attention. This article focuses on Sabbath in dialogue with Jewish and Christian writings, particularly with regard to the dignity of work, sacred time, and receptive relationship to God and all of creation. Considering Catholic teachings on Sunday and Sabbath, I develop the idea of liturgical listening, arguing that the Eucharistic assembly can be a formative space for cultivating practices of listening together.

Barriers and Facilitators in Implementation of Nutritional Benefit Transfer to Tuberculosis Patients

Abstract Background Malnutrition & Tuberculosis (TB) form a vicious cycle. Nikshay Poshan Yojana (NPY) is a key strategy for a TB free India, that seeks to provide financial assistance for nutritional support to TB patients. The study is a qualitative study to identify operational challenges and facilitators in implementation of NPY Methods In Depth Interview (IDI) of 18 Senior Treatment Supervisor (STS) at Tuberculosis Unit (TU) and 19 Tuberculosis Health Visitor (TB HV) at Designated Microscopy Centre’s (DMC) was done. For further insights, the STS, at District Tuberculosis Centre, Lucknow was also interviewed. Informal discussion was done with about 50 Tuberculosis patients. We explored providers perspective on impact of NPY on other duties/services, case load, hours dedicated to NPY, practice protocols, record keeping and data management, compliances, capacity building needs, quality protocols, key enablers, motivating factors, challenges, best practices and beneficiary’s perspectives on quality of life, facilitators and challenges in availing services. Results Motivating leadership, supportive staff, good working relationship and seamless communication, teamwork, use of technology, supportive supervision & collaboration and support of NGO for private sector were the key facilitators. Barriers comprised system level barriers (Budget constraints, issues with NIKSHAY software and bank account), provider level barriers (shortage of human resource, nonfunctional tablets) and patient level barriers (stigma and bank account related challenges). The encouraging finding was majority of recipients, responding that they used the incentive to purchase ration, vitamin supplements etc. Conclusions NPY is having its intended benefit but there are barriers that need to be resolved for successful roll out. The study yield suggestions for removing barriers and found a set of innovations that can be replicated across other settings with high Tuberculosis burden Key messages • Malnutrition and Tuberculosis form a vicious cycle. Nutritional support to TB patients improves treatment outcome and can save lives. • Operational research on implementation of NPY offers insights for successful roll out of this key initiative across other resource limited settings in developing countries.

Hospital policies as a tool to reduce gaps between ethnic groups of employees and patients

Abstract Background As diverse organizations, hospitals require an inclusive culture that respects and promotes ethnic diversity. Violence, a threat to this diversity, hampers effective organizational functioning. Our study delves into the positive influence of cultural diversity policies and communication about violence on the perception of the hospital’s atmosphere regarding ethnic differences among health employees. It enhances hospital labor relations and mitigates the risk of workplace violence. Methods 372 hospital employees with an average tenure of 6.5 and an average age of 38 filled out an online close-ended questionnaire (83% are Israeli Jews, 68% are female). 91% report working closely with people from different ethnic origins. Respondents ranked the atmosphere in the hospital regarding ethnic differences between employees and patients, the hospital’s cultural diversity policy, and organizational communication about violence. Data were analyzed by SPSS 28. Results Positive correlations were found between variables. A positive atmosphere was significantly related to the hospital’s cultural diversity policy (r=.14, p=.002) and to organizational communication about violence (r=.22, p< .001). However, the regression analysis (with control variables age, sex, and managerial role) revealed that despite employees acknowledging the hospital’s efforts to address diversity and violence, these factors only predict 10% of the variance of the hospital atmosphere [F(5, 366) = 8.346, p < .001; R²=.10]. Conclusions The hospital should increase actions that will improve the ethnic atmosphere in the hospital. Understanding how the encounter, where employees and patients from diverse ethnic backgrounds interact, influences the hospital’s atmosphere is crucial. These interactions can lead to tensions and offensive behaviors toward employees if not managed well. Hospitals can create an inclusive and harmonious work environment by addressing these tensions. Key messages • A cultural diversity policy and communication are necessary to maintain harmonious working relationships. It is essential, particularly in health organizations characterized by ethnic diversity. • Reducing the perception of ethnic differences may increase well-being and decrease violence. While hospitals often don’t prioritize these issues, this study forefront their influence and importance.

Co-producing research on universal health system reform in the context of COVID-19

Abstract Issue How to co-produce and embed research into universal health system reform implementation in the context of COVID-19. In many respects the pandemic revolutionised the use of data and research, with near real-time data informing key health policy and system decisions. This was evident in the production of publicly available data sets tracking COVID-19 infection as well as health system dashboard tracking activity in real-time and influencing day-to-day decisions made. How can this use of data and research evidence become the norm for all health system reform and policy decisions? Results The Foundations’ research project is a partnership project in place since Autumn 2019. Initially focused on producing evidence to inform the design and implementation of new regional areas with the Department of Health Sláintecare Reform Office and the Irish national Health Service Executive as partners. When COVID-19 occurred all work on the regions was paused the research pivoted to harness the learnings form the COVID-19 response to inform universal health system reform. The partnership applied research nature of the programme allowed research to be coproduced and co-designed with health system leaders, meant the researchers understood if and when it was possible to engage with partners and how to feed result into the health system at the earliest opportunity. Lessons Trust and pre-existing working relationships with partners allowed the research to pivot and to continue during the pandemic. The applied partnership nature of the research meant that at times the health system was very engaged in the research and at other times (eg during COVID waves and surges or the cyber-attack) there was limited engagement. The co-production nature of the research allowed a dynamic, ongoing, two-way learning between the health system and the research team. It is extremely difficult to measure impact of research on health system and reform decisions.

Co-producing evidence to inform universal health coverage implementation in Ireland: 2019-2024

Abstract Background In 2017, Ireland’s parliamentary health committee published a ten-year health reform plan, entitled Sláintecare, with the aim of delivering universal healthcare. Endorsed by government in 2018, progressing Sláintecare remains government policy in 2024. In 2019, Prof Burke was awarded public funding to co-produce knowledge for the design and implementation of the regions, a key aspect of Sláintecare. In 2020, with the arrival of COVID-19, regional reform was paused and the research pivoted to capture the learning from the COVID-19 health system response to inform Sláintecare. In 2022/3, the research returned to focus on the regions. Methods Foundations’ research resulted in 14 peer-reviewed publications between 2019 and 2023. These were mixed-methods using qualitative and quantitative data and analysis. Coproduction with health system leaders that were devising and implementing the regions and the COVID-19 health system response underpinned the research. Results There are 14 academic publications from the Foundations Research (2019-2023). At the core of co-production is trust and good working relationships. Co-producing research with senior policy makers and implementers has benefits and drawbacks. The benefits include access to resources and data and that the data and knowledge generated are more likely to be adopted. Drawbacks include control over areas researched, denial of access to data and lack of openness to research findings. Producing controversial findings, unpopular with government, minister or health system leaders can also lead to difficulties for the research team. Discussion/conclusions Details of the coproduction process with senior health system and policy leaders will be presented. It will detail specific examples of the research which were initiated by the health system and those that came from the academic research team. It will give examples of how the research influenced the policy making and implementation processes. Key messages • Co-producing research between academics and health system and policy leaders leads to better use of evidence. • Trust and good workign relationships are key to co-producing research that is used in policy making and implementation processes.

Neither Employment nor Self‐Employment: Avenues Towards Functional Platform‐Mediated Work Systems

ABSTRACTDigital labour platforms are contested because they create work relationships that neither fall into the category of traditional employment nor fulfil the criteria of freelance work due to platforms’ heavy interference in the work process. Although existing research has elucidated different pathways for improving the working conditions of platform workers, we develop an employment relations perspective on platform‐mediated work systems building on David Marsden's theory of employment systems. On the basis of an assessment of the psychological, economic and legal contracts underlying platform‐mediated work, we discuss the limited functionality of these contracts in their ability to control opportunism among platforms, workers and clients. Our analysis contributes to existing debates by providing a theoretically informed framework for analysing the design of platform‐mediated work systems and their consequences for the participating parties. Our insights add nuance to the platform regulation debate by going beyond the question of worker classification towards understanding the organizational and institutional elements of the work system that need to be redesigned and supported by appropriate institutional safeguards. An employment systems perspective also allows for reflection on the economic, societal, sectoral and strategic conditions that could drive such changes.

Servant leadership and healthy work relationships in university context: a moderated mediation analysis of psychological safety and socially responsible leadership

Servant leadership and healthy work relationships in university context: a moderated mediation analysis of psychological safety and socially responsible leadership

Boosting Employee Performance: The Roles of Motivation, Work Environment, Discipline, and Communication

The purpose of this research is to examine the influence of work motivation, work environment, work discipline and communication on the performance of PT United Tractors Cakung CGS Division Employees. This type of research is explanatory research. The sampling technique uses salted samples. Data was collected using a survey method using a questionnaire. The data analysis method used is multiple linear regression analysis. The research results show that (1) work motivation has a positive and significant effect on employee performance. (2) The work environment has a positive and significant effect on employee performance. (3) work discipline does not have a significant effect on employee performance. (4) communication has no significant effect on employee performance. (5) work motivation, work environment, work discipline, and communication simultaneously influence employee performance. The managerial implications that can be drawn from these findings are very important for effective human resource management. First, high work motivation can be increased by providing appropriate incentives and encouraging employees to achieve higher targets. Second, a conducive work environment can be created by arranging a comfortable and safe workspace, as well as ensuring good working relationships between employees.

The adoption and implementation of local government planning policy to manage hot food takeaways near schools in England: A qualitative process evaluation

IntroductionAccess to hot food takeaways, particularly near schools, is of growing concern for policymakers seeking to reduce childhood obesity globally. In England, United Kingdom (UK), local government jurisdictions are implementing planning policies to reduce access by restricting or denying planning permission for new takeaway outlets near schools. We used a qualitative approach to explore local government officers’ perspectives on the barriers to and facilitators of the adoption, implementation, and perceived effectiveness of these policies. MethodsIn 2021–2022, we conducted semi-structured interviews with 29 local planning (‘planners’) and public health government officers from 15 different local authorities across England who adopted a policy to restrict new takeaways. Data were analysed thematically. ResultsParticipants explained that they mostly thought the policies facilitated the refusal of applications for new takeaways near schools. However, participants speculated that businesses identified alternative opportunities to operate including functioning as ‘restaurants’ or within other locations. Effective working relationships between planners and public health officers were important for adoption and implementation, although planning and public health agendas did not always align and there were tensions between economic development and health improvement goals. The policy was adapted to suit local needs and priorities; in some cases, the policy was not used in areas where economic growth was prioritised. Clarity in policy wording and establishing a formal process for implementing policies including a designated individual responsible for checking and reviewing takeaway applications helped ensure consistency and confidence in policy implementation. ConclusionAlthough sometimes challenging, the policies were commonly described as feasible to implement. However, they may not completely prevent new takeaways opening, particularly where takeaways are relied upon to enhance local economies or where takeaway businesses find alternative ways to operate. Nevertheless, the policies can serve to shift the balance of power that currently favours commercial interests over public health priorities.

Factors that affect the implementation of an integrated care programme for older people with different frailty levels: a qualitative study of commissioners and provider stakeholders

IntroductionThe NHS has made it mandatory for General Practices in England to proactively identify and manage older people with moderate and severe frailty since the GMS contract of 2017/2018. In Luton, stakeholders developed the Luton Framework of Frailty (LFF) to implement this national policy. The aim of this study was to explore the factors that affect the implementation of this national policy at a local level.MethodsIn-depth interviews were conducted with 18 commissioners and service providers, all of whom were involved in providing services for older people with different frailty levels (OPDFL). Purposive and snowball sampling methods were used, with thematic analysis used for data analysis.ResultsTwo main themes with several sub-themes were found. The first theme was the tension within existing national policy initiatives to provide integrated care services for OPDFL, which illuminated their strengths and limitations. Participants felt that new initiatives, such as the development of Primary Care Networks and Enhanced Health in Care Homes, have improved primary care coordination. However, the traditional reactive approach for managing older people who are frail was thought to be counterproductive, when an approach that focused on prevention and early intervention would have been better. The second theme concerned the contextual factors that affect implementation of integrated care. These included having key leaders at a local level, the requirement for more funding, as well as the need for good working relationships among service providers. However, the lack of awareness about the care pathways among GPs was thought to be a reason for the variation in the implementation of the LFF. The COVID-19 pandemic was perceived as a challenge for the implementation of the LFF. Finally, polices were thought to succeed only if more resources are provided, while the term frailty should be used with caution due to the negative connotations of OPDFL towards this term.ConclusionThe implementation of an integrated care programme for OPDFL can be affected by several factors. Having proactive national policies that facilitate coordination and, having key leaders locally, the need for more funding, and good working relationships, are some of the contextual factors that could facilitate a successful implementation. In contrast, the lack of awareness of the care pathways that have been introduced locally, insufficient resources to deliver the programmes efficiently and a lack of careful consideration of how the term frailty is used could hinder this being put into practice.

From classroom to collaboration: how pre-graduation interprofessional learning shapes health professional graduates’ interactions in practice

ABSTRACT Interprofessional education (IPE) aims to prepare health professional students with the knowledge, attitudes and skills required for collaborative healthcare practice. Although positive outcomes have been documented at the completion of university-based IPE experiences, or longitudinally across health care degrees, the literature is unclear on how university-based IPE influences graduate practice. This study therefore explores how health professional graduates experience interprofessional interactions in practice and how these may be connected to their university-based IPE experiences. Interviews with seven health professional graduates who had participated in an 11-week IPE course as part of their pre-licensure degrees were analyzed using interpretative phenomenological analysis. The participants were able to articulate instances of effective and less effective collaboration from their professional experiences, making sense of these experiences with explicit reference to the themes of role understanding, collaborative working relationships, interprofessional communication, patient-centered care and contextual influences; all ideas introduced in their university-based IPE. They connected their understanding of roles, collaborative working relationships and interprofessional communication explicitly to their prior university-based IPE, identifying these learnings as foundational knowledge. This connection was not as explicit for patient-centered care and contextual issues. These findings highlight the critical importance of IPE in preparing health professionals for high-quality contemporary practice.

Education and ideological polarisation: Cross‐country evidence and recommendations for higher education

AbstractIn many developed countries, disagreement on important policy issues between groups with different social identities (‘ideological polarisation’) is increasing. In professional settings, these disagreements undermine cooperation and trust between employees, which negatively affects work relationships and managerial decision‐making. We investigate whether people with more education tend to express attitudes that are more (or less) polarised. Using nationally representative data for 18 OECD countries from 2010 to 2018, we find that in most countries, ideological polarisation between liberals (political left) and conservatives (political right) on three key policy issues (income inequality, immigration and gay rights) increases with education. This ‘education–polarisation’ gradient varies across countries, is strongest in the United States and is linked to stronger alignment between political ideology and non‐political values, and greater internet use among more‐educated individuals. This finding can explain why polarisation can persist and even increase, despite the growing availability of information. We conclude with implications and recommendations for higher education.

The effects of cultural humility on therapeutic alliance and psychotherapy outcomes: A systematic review and meta‐analysis

AbstractAimThe present review and meta‐analysis sought to synthesise previous findings of studies examining the correlation between therapist cultural humility, the quality of the therapeutic alliance and psychotherapy outcomes.Materials and MethodsThree databases were searched for relevant citations, yielding 548 records for review. After the systematic review of these articles, a final sample of 13 citations was submitted for coding and analysis. A random‐effects meta‐regression model was used to synthesise correlations collected from the final sample of studies. Heterogeneity was assessed using Cochran's Q, I2 and τ2. Publication bias was assessed using contour‐enhanced funnel plots and Egger's test for asymmetry.ResultsThere was a statistically significant, positive correlation between cultural humility and alliance quality (r = .66, 95% CI = [0.64, 0.68]). Similarly, a smaller, yet still statistically significant and positive association between cultural humility and psychotherapy outcomes was also found (r = .39, 95% CI = [0.36, 0.42]). Moderators related to client race, gender and lesbian, gay and bisexual (LGB) status were also examined though nonsignificant.ConclusionSuch results suggest that therapist cultural humility is an important part of a strong working relationship and eventual positive outcomes in psychotherapy regardless of race, gender or LGB status. Thus, efforts should be made to foster cultural humility among therapists.

The triangular relationship in platform gig work: Consumers, platform beneficence and worker vulnerability

AbstractPlatform gig work is created and contested in dynamic, triangular relationships between platforms, workers, and consumers. Compared with the first two groups, however, evidence about the role of the third—consumers—is sparse. In this paper, we investigate consumers' changing perceptions of work in the platform gig economy and argue that their perspective warrants greater attention in sociological analyses. Using data from two Australian public opinion surveys conducted 5 years apart (2017 and 2022), we explore how consumers' views of platform gig work evolved during a period of rapid change that includes the first 2 years of the COVID‐19 pandemic. We find that while overall platform use increased markedly, many consumers felt conflicted about gig workers' conditions and key features of platforms' typical labour practices. There is a pronounced, enduring, and consequential tension in consumers' views of the merits and drawbacks of this work; between, on the one hand, an acceptance that platforms do benefit workers to some extent and, on the other hand, misgivings about workers' vulnerability to harm. In centring consumers, our paper empirically enriches current triangular conceptions of labour relations in the platform gig economy, by showing how consumers mediate the interests of platforms and workers, to shape how gig work manifests and who benefits from it. We also contribute useful new practical knowledge, by elucidating the prevailing concerns of consumers that could be developed into resonant themes for campaigns aimed at improving platform gig workers' rights.

Effective Communication Strategies for Business Analysts to Bridge the Gap between IT and Finance

As organizations depend more on technology to stay ahead of the competition, their information technology (IT) and business departments must work together closely. However, cultural differences and understanding between the specialized fields often make it hard for them to work together effectively. If these issues are fixed, they could make it easier to finish projects, stick to budgets, and agree on the company's goals. Many companies use business analysts to help people talk to each other by acting as liaisons knowledgeable in technology and finances. However, there is limited information in the literature about how analysts can connect the tasks. This study fills that gap by looking into the problems when IT and finance work together and suggesting specific steps analysts can take to improve strategic alignment. Looking at past studies shows that common differences make it hard for people to work together. IT and finance use different vocabularies for technical terms and project-based versus financial terms, leading to misunderstandings. They also set other priorities. It emphasizes speed of innovation and technical practicality, while finance emphasizes reducing risk, accuracy, and returns. There are also differences in the amount of knowledge and skill that people in IT and finance have regarding technical solution details and financial effects. They also use different ways to make decisions. IT bases judgments on technological factors, while finance assesses business impact. Besides, cultural norms diverge between the flexible and creative IT culture and the rigorous and methodical finance culture. Business analysts should utilize several focused communication strategies to close these gaps. Creating a shared vocabulary helps terms from diverse fields fit. Regular mapping and stakeholder conversations help you grasp other perspectives. Actively listening, repeating, asking questions, and summarizing shows you comprehend. Educating on decision-making variables and expertise broadens perspectives. Discussing cultural meanings and making sure individuals understand questions improves discussion. Using shared goals like increasing sales or lowering costs is another way to unite people around similar goals. By using these specific methods, business experts can help IT and finance work together despite cultural differences. Mapping and teaching regularly help keep relationships strong even as needs and staff change. By focusing on active listening, aligning vocabulary, and highlighting shared interests, you can build good working relationships necessary to get strategic benefits from technology investments.

“Making a Difference”: Interpreting Responsivity Ambience for Parole Work

In this article, we draw on qualitative interview data (n=150) from parole officers (POs) employed in Canada’s federal correctional service. Our analysis interprets job satisfaction, accountability, and relational aspects of POs’ work, taking a semi-grounded constructivist approach. We discovered correctional workers, such as probation and parole officers, engage in transformational relationships within their workplace environments. However, given economic, social, and political constraints, we question how these change agents actually ‘make a difference’ in practice. Fidelity to core correctional practices suggests therapeutic alliances are fundamental to intervention. Emergent in our discoveries is how the workplace environment, organizational climate and culture, and penal atmosphere mediate reflexive experiences that inspire motivation, morale, and change. However, our interpretation and situational awareness of parole adds to a lacuna in knowledge about therapeutic relationships in correctional work generally and the responsivity principle specifically for sensemaking about how interventions may sometimes become iatrogenic. We found that POs negotiate their relationships with those under supervision as much as with fellow correctional workers. Responsivity ambience pertains to consolidation and conceptual clarity concerning how corrections, in its public safety mandate, induces in/efficacy. Through discussion, we theorize how securitized settings affect well-being and provide practical insights to converge on the rehabilitative ideal and criminal desistance.

“Tell me I’m okay”: A cross-sectional quality-of-life assessment of patients in a breast cancer survivorship program.

213 Background: The number of breast cancer survivors is increasing due to improvements in care and an aging population, leading to an increased need for care that addresses the physical and psychological needs of patients after completion of active treatment. The Sunnybrook Breast Cancer Survivorship Program was established to provide comprehensive evidence-based survivorship care and facilitate the transition to family doctors. Despite rising interest in dedicated survivorship care, there is little consensus regarding which individuals are likely to suffer the most long-term impacts of breast cancer treatment. Factors as varied as age, ethnicity, socioeconomic status, and treatment type can influence Quality-of-Life (QoL) outcomes. This cross-sectional assessment uses mixed methods to evaluate QoL trends in the patient cohort. Methods: Current patients of the Sunnybrook Breast Cancer Survivorship Program were asked to complete a baseline information form, as well as the EORTC QLQ-30 and BR-45, two validated measures of QoL for breast cancer patients and survivors. QoL, functional, and symptom domains were calculated from these responses accordingly and analyzed statistically. Patients reported their most bothersome QoL concerns through an open-ended questionnaire, which was analyzed and organized thematically. 99 patients have been recruited to date, of a planned 200. Results: We find that sexual health is of importance for this population, with 50 (50.5%) participants reporting sexual activity. Patients under 50 have poorer sexual functioning scores (p<0.01) as well as more issues with body image (p<0.05) than older survivors. Both married and under-50 patients are significantly more likely to have poorer outlooks on the future (p<0.05; p<0.01). Younger patients also tended to have worse role functioning, cognitive functioning, emotional functioning, and social functioning scores, though these differences were not statistically significant. Thematic analysis of qualitative data showed that patients’ chief concerns were the impact that ongoing side effects had on their daily functioning, impact of treatment on body image, disruptions to work and personal relationships, and strong anxiety about potential recurrence. Conclusions: While it is understood that younger BC survivors face unique challenges, our findings indicate that these obstacles persist into older age groups. In addition to physical side effects, such concerns as body image issues, social strain, and emotional functioning can drive QoL scores for these patients. Notably, many patients endorsed strong anxiety regarding potential recurrence that affected QoL, and identified dedicated survivorship follow-up as an ameliorating factor. Further research should be conducted into the unique needs of under-50 survivors, as well as the role of recurrence anxiety in impacting QoL.

Salutogenic mechanisms in nature-based work: fostering sense of coherence for employees with limited capability for work.

Having a job is important for the well-being and inclusion of people with limited capability for work (LCW) due to physical and/or mental disability. This study explores salutogenic mechanisms that contribute to work-related sense of coherence (Work-SoC) of employees with LCW, i.e. perceiving their work in nature as manageable, comprehensible and meaningful. Semi-structured interviews (26 in total) were conducted with employees with LCW, employee supervisors, job coaches and foresters, all working in nature management. Interviews were held at four worksites of a governmental organisation in the Netherlands that provides permanent jobs for people with LCW. Employees with LCW contributed to the design and analysis of the study as co-researchers. Thematic analysis was used and member checks were carried out on preliminary findings. We identified six salutogenic mechanisms that contribute to nature-based Work-SoC of employees with LCW: (i) having constructive working relationships, (ii) experiencing structure and clarity, (iii) receiving practical and emotional support, (iv) support in the creation of meaning, (v) experiencing and learning in practice and (vi) physical activity and (absence of) stimuli. Identified mechanisms can create a positive effect when leveraged, thereby boosting (new) salutogenic mechanisms. Our findings illustrate that nature-based work can provide resources that promote Work-SoC of employees with LCW through the identified mechanisms. However, employees with LCW, colleagues, supervisors and stakeholders must recognize, mobilize and use these resources to leverage identified mechanisms in order to facilitate health-promoting workplaces for people with LCW. This, in turn, can contribute to sustainable inclusion through enablement.

When Saying "No" is the Right Choice: Tactfully Declining Managerial Promotions

This article discusses best practices for respectfully declining premature promotions into management roles as a consultant or academic, in order to avoid sabotaging one's career or damaging relationships. It emphasizes the importance of self-reflection to understand one's skills and interests before committing, and encourages politely but firmly communicating priorities and boundaries. Specific techniques are presented, such as expressing gratitude for the confidence in one's abilities while reinforcing current focus on individual work. Offering compromises like trial periods can demonstrate continued commitment while avoiding premature transitions. Validating others' perspectives and emphasizing shared goals helps smooth potential hurt feelings. The article notes the importance of providing thoughtful rationale, validating concerns, proposing alternatives, and focusing on mutual benefit over the long run. Earlier missteps are contrasted with refined approaches developed through situations navigated over time. The conclusion stresses how even difficult conversations can strengthen dynamics when both self-interests and the relationship are kept in mind, with a solution-oriented focus on constructive exchange and partnership beyond any individual opportunity. Overall, the article presents concrete methods for declining roles respectfully while preserving professional integrity and valuable working relationships.