Dag Hofoss

Predictors of job satisfaction among doctors, nurses and auxiliaries in Norwegian hospitals: relevance for micro unit culture

ObjectiveTo explore what domains of work are important for job satisfaction among doctors, nurses and auxiliaries and to discuss differences between professional groups in the perspective of micro team culture.DesignCross-sectional survey data from hospital staff working clinically at inpatient hospital wards in Norway in 2000.MeasuresLinear regression models predicting job satisfaction for the three professions were compared. First, five domains of hospital work were examined for general job satisfaction. Based on the result of the first regression, five items concerning local leadership were explored in a second regression.ResultsA total of 1814 doctors, nurses and auxiliaries working at 11 Norwegian hospitals responded (overall response rate: 65%). The only domain of work that significantly predicted high job satisfaction important for all groups was positive evaluation of local leadership. Both steps of analyses suggested that professional development is most important for doctors. For registered nurses, experiencing support and feedback from the nearest superior was the main explanatory variable for job satisfaction. Job satisfaction of auxiliaries was equally predicted by professional development and local leadership. The results are discussed and interpreted as reflections of cultural values, loyalties and motivation.ConclusionThe professional values of medicine, the organizational and holistic skills of nurses and the practical experience of auxiliaries should all be valued in the building of interdependent micro teams.

Cingulum fiber diffusivity and CSF T-tau in patients with subjective and mild cognitive impairment

Diffusion tensor imaging (DTI) and CSF biomarkers are useful diagnostic tools to differentiate patients with mild cognitive impairment (MCI) from normal controls, and may help predict conversion to dementia. Total Tau protein (T-tau) and DTI parameters are both markers for axonal damage, thus it is of interest to determine if DTI parameters are associated with elevated CSF T-tau levels in patients with cognitive impairment. For this purpose, patients with subjective cognitive impairment (SCI) and MCI were recruited from a university based memory clinic. Regions of interest were used to determine fractional anisotropy (FA), radial diffusivity (DR) and axial diffusivity (DA) in known white matter tracts in patients with MCI (n=39) and SCI (n=8) and 26 cognitively healthy controls. Significant lower FA and higher DR values were observed in patients with pathological vs. patients with normal CSF T-tau levels and vs. controls in left posterior cingulum fibers. T-tau values were negatively correlated with FA and positively correlated with DR values in the posterior cingulum fibers. Cingulum fiber diffusivity was related to T-tau pathology in SCI/MCI patients and altered DR may suggest that loss of myelin contributes to early white matter changes in patients at risk of developing Alzheimers disease (AD).

General practitioners’ relationship to sickness certification

Objective. GPs’ role conflict in connection with sickness certification is widely accepted. The authors explored the relationship between GPs and this difficult task. Design. Cross-sectional questionnaire study of experiences, attitudes, and management of sickness certification. Data were analysed by hierarchical cluster analysis. Setting. Norway. Subjects. Representative sample of 308 general practitioners from a nationwide panel established by the Research Institute of the Norwegian Medical Association. Main outcome measures. Differentiation of response patterns regarding perceived burden, self-evaluation, doubt, permissiveness, opinions on whether sickness certification is a medical task, and sociopolitical attitude. Associations with hours of patient contact per week, number of sickness certifications per week, job satisfaction, degree of paternalism, and personality characteristics. Results. Four groups evolved, one (12%) with low burden, high self-esteem, little doubt, and permissiveness, another (12%) with the opposite characteristics. They displayed similar sociopolitical attitudes. The third group (32%) was primarily characterized by a biomedical attitude, while the fourth represented a middle position in all dimensions. The first two groups differed on personality characteristics. There were no differences between groups regarding number of sickness certifications per week, job satisfaction, or degree of paternalism. Conclusions. Prominent differences in experiences with sickness certification between groups of doctors exist. No evidence was found of associations between group-level GP differences and sickness certification rates.

Patient experiences with information in a hospital setting: a multilevel approach.

Background. Patients tend to be critical of poor communication and the provision of information from health professionals. One explanation may be related to organizational aspects characterizing the hospital unit. Studies have indicated quality of contact with nursing staff to be a major determinant of patients’ experiences with information. Yet many studies do not simultaneously analyze the effects of patient and unit characteristics. Objective. To explore the extent to which variation in patients’ experiences with the provision of information from hospital staff are associated with differences between patients, and the extent to which they are associated with differences between hospital wards. Research Design. Cross-sectional study of patients nested within hospital wards including hospital administrative data and survey data on patients’ experiences with hospital care and nurses’ assessments of working conditions and job satisfaction. Results. Multilevel regression analysis indicated low intraward correlation and high within ward variability. In explaining variability in experiences with information, patients’ sense of coherence was the most important patient-level characteristic. The percentage of nurses satisfied with their work contributed to an additional proportional reduction in variance between hospital wards. Conclusions. This study has illustrated the use of multilevel methods in analyzing patient perceptions of hospital care. Ward-level factors are at most modestly related to patients’ experiences with information. The effect of hospital, department, and ward characteristics is likely to be mediated through the existence of microunits within hospital wards. Quality of contact with nursing staff may be a characteristic of the microunit rather than an organizational characteristic related to hospital wards.

The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals : A cross-sectional study

BACKGROUND Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals. OBJECTIVE To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level. DESIGN A cross-sectional study. SETTING Six of the 11 invited hospitals in South-Eastern Norway agreed to participate. PARTICIPANTS Inpatients ≥18 years at 88 somatic hospital wards (N=1209). Patients in paediatric and maternity wards and day surgery patients were excluded. METHODS The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels. RESULTS The prevalence was 18.2% for pressure ulcer category I-IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level. CONCLUSIONS Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important.

White Matter Lesion Subtypes and Cognitive Deficits in Patients with Memory Impairment

Aim: To analyze the relationship between periventricular (PV) and subcortical (SC) white matter lesions (WML) and cognitive function in patients with memory impairment. Methods: In total, 253 patients with Global Deterioration Scale scores ≧3 who had been referred to a university-based memory unit due to memory complaints were included (mean age 69.7 years, 124 females). Cognitive function was assessed with the Mini-Mental State Examination (MMSE) and the Neurobehavioral Cognitive Status Examination (Cognistat), and full test results were available for 217 patients. PV and SC WML loads (semi-quantitative rating on axial T2-weighted MRI scans) were used in linear regression as predictors of cognition. Results: MMSE was significantly correlated with SC WML (p = 0.005), but not with PV WML (p = 0.19). Cognistat tests for orientation, comprehension, visuoconstruction, calculation, similarities, and judgment were negatively correlated with SC WML (p < 0.01), as was verbal memory with parieto-occipital SC WML (p < 0.05). Visuoconstruction and calculation were negatively correlated with PV WML (p < 0.05). Parieto-occipital WML were more strongly related to cognition than fronto-temporal WML. Only SC WML were significantly correlated with cognition when PV and SC WML were entered simultaneously in the regression model. Conclusion: In patients with cognitive impairment, SC WML, in particular in parieto-occipital regions, were associated with reduced cognitive function.

Self-reported headache in schoolchildren: parents underestimate their children's headaches.

Background: Most previous studies of childhood headache have used indirect parental/physician reports to estimate the prevalence of headache in children. Aim: To use direct information from children and to compare the results with data collected from parents. Study design/methods: A cross‐sectional questionnaire was sent to parents of 7–12‐y‐olds in Oslo, Norway. The questionnaire included retrospective reports by the parents of the presence of headache among their children during the past 6 mo. A panel study was subsequently done with daily diaries completed by the children over 6 wk. This was done at school. Results: For 2126 children, both diary reports and parental reports were available. We found a 1‐mo prevalence of self‐reported headache of 57.6%. Parents, particularly fathers, reported lower headache prevalence than the children. The difference between parental reports and those of the children was larger when the child was a girl. There was a clear difference for the youngest children and parental underreporting for children with the most frequent headaches.

Sufficient competence in community elderly care? Results from a competence measurement of nursing staff

BackgroundMulti-morbidity, poly-pharmacy and cognitive impairment leave many old patients in a frail condition with a high risk of adverse outcomes if proper health care is not provided. Knowledge about available competence is necessary to evaluate whether we are able to offer equitable and balanced health care to older persons with acute and/or complex health care needs. This study investigates the sufficiency of nursing staff competence in Norwegian community elderly care.MethodsWe conducted a cross-sectional survey of 1016 nursing staff in nursing homes and home care services with the instrument “Nursing Older People – Competence Evaluation Tool”. Statistical analyses were ANOVA and multiple regression.ResultsWe found that nursing staff have competence in all areas measured, but that the level of competence was insufficient in the areas nursing measures, advanced procedures, and nursing documentation. Nursing staff in nursing homes scored higher than staff in home care services, and older nursing staff scored lower than younger nursing staff.ConclusionsA reason for the relatively low influence of education and training on competence could be the diffuse roles that nursing staff have in community elderly care, implying that they have poor standards against which to judge their own competence. Clearer role descriptions for all groups of nursing staff are recommended as well as general competence development in geriatric nursing care.

The Northern Norway Mother-and-Child Contaminant Cohort (MISA) Study: PCA analyses of environmental contaminants in maternal sera and dietary intake in early pregnancy

BACKGROUND Although predictors of contaminants in serum or whole blood are usually examined by chemical groups (e.g., POPs, toxic and/or essential elements; dietary sources), principal component analysis (PCA) permits consideration of both individual substances and combined variables. OBJECTIVES Our study had two primary objectives: (i) Characterize the sources and predictors of a suite of eight PCBs, four organochlorine (OC) pesticides, five essential and five toxic elements in serum and/or whole blood of pregnant women recruited as part of the Mother-and-Child Contaminant Cohort Study conducted in Northern Norway (The MISA study); and (ii) determine the influence of personal and social characteristics on both dietary and contaminant factors. METHODS Recruitment and sampling started in May 2007 and continued for the next 31 months until December 2009. Blood/serum samples were collected during the 2nd trimester (mean: 18.2 weeks, range 9.0-36.0). A validated questionnaire was administered to obtain personal information. The samples were analysed by established laboratories employing verified methods and reference standards. PCA involved Varimax rotation, and significant predictors (p≤0.05) in linear regression models were included in the multivariable linear regression analysis. RESULTS When considering all the contaminants, three prominent PCA axes stood out with prominent loadings of: all POPs; arsenic, selenium and mercury; and cadmium and lead. Respectively, in the multivariate models the following were predictors: maternal age, parity and consumption of freshwater fish and land-based wild animals; marine fish; cigarette smoking, dietary PCA axes reflecting consumption of grains and cereals, and food items involving hunting. PCA of only the POPs separated them into two axes that, in terms of recently published findings, could be understood to reflect longitudinal trends and their relative contributions to summed POPs. CONCLUSIONS The linear combinations of variables generated by PCA identified prominent dietary sources of OC groups and of prominent toxic elements and highlighted the importance of maternal characteristics.

The self-perceived health status of Norwegian physicians compared with a reference population and foreign physicians

Aims: To compare the self-perceived health status of a representative sample of Norwegian physicians with a general reference population; and to investigate differences in health status among groups of physicians. Methods: A cross-sectional postal survey was carried out of 1,126 Norwegian physicians and 1,742 subjects in a general reference population, using the widely used general health status questionnaire - Short Form 36 (SF-36). Scores were adjusted for differences in age, gender and education where applicable. Results: The health status of Norwegian physicians was better than that of subjects with a lower level of education in the four dimensions of the SF-36 related to physical health. Male physicians scored better on the physical functioning scale and lower on vitality and social functioning than comparable university graduates. Older physicians scored better than younger in dimensions related to mental health and social functioning. Norwegian general practitioners reported better health status than colleagues in Sweden and the UK. Conclusions: The self-perceived health status of Norwegian physicians was as good or better than that of the general population. The cross-national differences could be caused by cultural differences, or be related to practice style or job strain.