Inge Varekamp

Exploring the return-to-work process for workers partially returned to work and partially on long-term sick leave due to common mental disorders: a qualitative study

Purpose. We conducted a qualitative study into the return-to-work process of workers partially on sick leave due to common mental disorders. Our objectives were to describe the barriers to a full return to work, solutions, communicating to the working environment and the aim of a full return to work, all as perceived by the workers. Method. Workers who had partially returned to work and were partially on long-term sick leave due to a stress-related, anxiety or depressive disorder were eligible for this study. Fourteen workers were interviewed and the interviews were transcribed verbatim and coded. Results. The perceived main barriers were: inability to set limits, recognise exhaustion and to control cognitions and behaviour such as perfectionism. A general pattern in the process was that all workers perceived barriers to a full return to work; most workers were able to mention solutions; all workers aimed for a full return to work, and after some time all workers were met with sufficient understanding and social support from their supervisor and health care professional. However, hardly any worker intended to implement or utilise the solutions at the workplace, except the structural adaptations of the work demands. Conclusions. The pattern we found suggests a critical intention–behaviour gap between solutions and intentions for a full return to work and its implementation at work. This implies that we should develop new interventions that focus on helping workers and their environment to bridge this gap.

Workplace problems and solutions for employees with chronic diseases

BACKGROUND While many employees who have a chronic disease manage their jobs well, others are hampered in work performance, experience work-related problems and are at risk for job loss. AIMS To identify the practical and psychosocial barriers recognized by employees with chronic disease who experience work-related problems and to examine preferred work accommodations. METHODS A questionnaire was sent by mail and completed by current workers who have a chronic disease and experience serious problems at work. RESULTS One hundred and twenty-two employees participated in this study. On average, they had been ill for 10 years and 44% had more than one disease. The most outstanding work-related problems were psychosocial, including work-home interference and a lack of acceptance of the chronic disease. Performing and finishing work tasks and social relationships with supervisors or colleagues were also felt to be slightly problematic. The most preferred work accommodations included fewer work hours, working from home, a slower work pace and more autonomy in planning work tasks. Almost three-quarters of the respondents were so fatigued that they were at risk of sickness absence or work disability. CONCLUSIONS A chronic physical disease may lead to both practical and psychosocial problems and serious fatigue. Managing psychosocial problems may decrease fatigue.

Facilitating Empowerment in Employees with Chronic Disease: Qualitative Analysis of the Process of Change

Introduction In the field of healthcare, empowering patients who have a chronic disease is defined as increasing their knowledge and skills, in order to enable them to define their treatment goals and take personal responsibility for their medical treatment. Our goal was to explore the nature of empowerment for employees who have a chronic disease and who experience work-related problems. Methods We used an explorative qualitative approach to document, from a professional perspective, the experiences of patients who participated in an empowerment training program. The researcher and the three instructors identified several themes which appeared to be important to many participants. These themes were fine-tuned and illustrated using brief case histories. Results We identified seven themes and characterized them in terms of employee tasks. These included: (1) developing a realistic understanding of one’s abilities, (2) standing up for oneself in a self-confident way, (3) maintaining social relations based on mutual understanding with supervisors and colleagues, (4) collecting and assimilating knowledge of one’s options, rights and duties, (5) consulting others and negotiating with regard to work accommodations, (6) planning one’s job so as to provide personal satisfaction, and (7) maintaining a social life outside work. Not every employee is faced with all of these tasks, but most have to deal with several. Conclusion Empowerment presupposes that employees with a chronic disease can act to solve problems at the workplace. The experiences during a comprehensive empowerment training illustrate that a process of reflection on personal emotions and a cognitive process of exploration and identification of bottlenecks at work may precede these actions. Our primary contribution is the aforementioned list of seven common tasks that many workers have to perform. Disseminating the list can support employees who have a chronic disease and may also be useful for their managers, HRM staff, occupational health and other healthcare workers.

Effect of job maintenance training program for employees with chronic disease - a randomized controlled trial on self-efficacy, job satisfaction, and fatigue.

OBJECTIVE Employees with a chronic physical condition may be hampered in job performance due to physical or cognitive limitations, pain, fatigue, psychosocial barriers, or because medical treatment interferes with work. This study investigates the effect of a group-training program aimed at job maintenance. Essential elements of the program are exploration of work-related problems, communication at the workplace, and the development and implementation of solutions. METHODS Participants with chronic physical diseases were randomly assigned to the intervention (N=64) or the control group (N=58). Participants were eligible for the study if they had a chronic physical disease, paid employment, experienced work-related problems, and were not on long-term 100% sick leave. Primary outcome measures were self-efficacy in solving work- and disease-related problems (14-70), job dissatisfaction (0-100), fatigue (20-140) and job maintenance measured at 4-, 8-, 12- and 24-month follow-up. We used GLM repeated measures for the analysis. RESULTS After 24 months, loss to follow-up was 5.7% (7/122). Self-efficacy increased and fatigue decreased significantly more in the experimental than the control group [10 versus 4 points (P=0.000) and 19 versus 8 points (P=0.032), respectively]. Job satisfaction increased more in the experimental group but not significantly [6 versus 0 points (P=0.698)]. Job maintenance was 87% in the experimental and 91% in the control group, which was not a significant difference. Many participants in the control group also undertook actions to solve work-related problems. CONCLUSIONS Empowerment training increases self-efficacy and helps to reduce fatigue complaints, which in the long term could lead to more job maintenance. Better understanding of ways to deal with work-related problems is needed to develop more efficient support for employees with a chronic disease.

Empowering employees with chronic diseases; development of an intervention aimed at job retention and design of a randomised controlled trial

BackgroundPersons with a chronic disease are less often employed than healthy persons. If employed, many of them experience problems at work. Therefore, we developed a training programme aimed at job retention. The objective of this paper is to describe this intervention and to present the design of a study to evaluate its effectiveness.Development and description of interventionA systematic review, a needs assessment and discussions with Dutch experts led to a pilot group training, tested in a pilot study. The evaluation resulted in the development of a seven-session group training combined with three individual counselling sessions. The training is based on an empowerment perspective that aims to help individuals enhance knowledge, skills and self-awareness. These advances are deemed necessary for problem solving in three stages: exploration and clarification of work related problems, communication at the workplace, and development and implementation of solutions. Seven themes are discussed and practised in the group sessions: 1) Consequences of a chronic disease in the workplace, 2) Insight into feelings and thoughts about having a chronic disease, 3) Communication in daily work situations, 4) Facilities for disabled employees and work disability legislation, 5) How to stand up for oneself, 6) A plan to solve problems, 7) Follow-up.MethodsParticipants are recruited via occupational health services, patient organisations, employers, and a yearly national conference on chronic diseases. They are eligible when they have a chronic physical medical condition, have a paid job, and experience problems at work. Workers on long-term, 100% sick leave that is expected to continue during the training are excluded. After filling in the baseline questionnaire, the participants are randomised to either the control or the intervention group. The control group will receive no care or care as usual. Post-test mail questionnaires will be sent after 4, 8, 12 and 24 months. Primary outcome measures are job retention, self efficacy, fatigue and work pleasure. Secondary outcome measures are work-related problems, sick leave, quality of life, acquired work accommodations, burnout, and several quality of work measures. A process evaluation will be conducted and satisfaction with the training, its components and the training methods will be assessed.DiscussionMany employees with a chronic condition experience problems in performing tasks and in managing social relations at work. We developed an innovative intervention that addresses practical as well as psychosocial problems. The results of the study will be relevant for employees, employers, occupational health professionals and human resource professionals (HRM).Trial registrationISRCTN77240155

Empowering employees with chronic diseases: process evaluation of an intervention aimed at job retention.

PurposeEmployees with a chronic disease may experience work-related problems that contribute to the risk of job loss. We developed a group-based intervention programme aimed at clarifying problems, making these a subject of discussion at work, and realizing solutions. This process evaluation investigates the intervention’s feasibility and the satisfaction of 64 participants in eight groups.MethodsData were collected through process evaluation forms and self-report questionnaires.ResultsThe recruitment of participants was time-consuming. Highly educated women working in the service sector were overrepresented. The programme was administered as planned, although components were sometimes only discussed briefly, due to lack of time. Satisfaction with the overall programme among participants was high; it was perceived as effective and there were only three dropouts. In particular, the focus on feelings and thoughts about having a chronic disease was highly valued, as were the exchange of experiences and role-playing directed at more assertive communication.ConclusionsA vocational rehabilitation programme aimed at job retention is feasible and is perceived to be effective. Such a programme should address psychosocial aspects of working with a chronic disease beside practical problems. The recruitment of participants is time-consuming. Cooperation with outpatient clinics is necessary in order to reach all groups of employees with a chronic disease that might benefit from job retention programmes. Trial registration: ISRCTN77240155

Workers with health problems: three perspectives on functioning at work

Purpose: Our aims were (i) to explore why it is that one worker with a health problem is able to stay at work while the other is not, (ii) to identify signals for decreased functioning at work, and (iii) to explore if and how this can be measured. Method: We conducted three focus groups: with workers with a health problem, occupational physicians, and human resources managers/supervisors. Results: Individual differences in coping strategies, motivation, believes, attitudes, and values were mentioned. All three groups reported that the supervisor is the key figure in the functioning at work of workers with health problems. The supervisor can facilitate the work accommodation of workers and help optimizing functioning at work. The identified signals might contribute to the development of an instrument. Conditions for use were suggested, i.e. a “safe” setting. Conclusions: This focus group study provided insight in why it is that one worker is able to stay at work while the other is not, according to the opinions of three different groups. Although all three groups reported that the supervisor is the key figure in the functioning at work of workers with health problems, there are differences between how the three stakeholders perceive the situation. Implications for Rehabilitation The supervisor is a key figure in the work functioning of workers with health problems; he/she can facilitate work accommodation of workers and help to optimize functioning at work. The three stakeholders show differences in how they perceive functioning at work; e.g. workers tend to focus on their health and working conditions, while the human resources managers/supervisors and occupational physicians also take the workers’ motivation, the attributed value of work, and the organizational culture into account. An instrument to measure work functioning might be beneficial to help workers with health problems to stay at work. These results can help in decision making for use of an existing work functioning instrument.

Evidence-based medicine voor de bedrijfsarts: zoekstrategieën voor de internationale literatuur over moeilijk objectiveerbare aandoeningen

SamenvattingPubMed biedt een vrij en makkelijk toegankelijk overzicht van de internationale literatuur over moeilijk objectiveerbare aandoeningen.

Chronische ziekte en langdurig verzuim op de werkplek: Maak werk van interactie tussen alle partijen!

SamenvattingMensen met een langdurige of chronische ziekte worden vaak belemmerd in hun werk. Zieke werknemers die op een positieve manier in gesprek zijn met hun omgeving hebben een kleinere kans op uitval uit het arbeidsproces. We werken twee voorbeelden uit van begeleiding wanneer werk in de knel komt: (1) empowerment, en (2) participatieve werkmethode.Empowerment training bij een chronische ziekte is bedoeld voor werknemers die door hun ziekte in de problemen komen. De training is opgezet voor een groep van acht deelnemers en één trainer. Er zijn zeven groepsbijeenkomsten en drie individuele gesprekken. De werknemer ontwikkelt inzichten en vaardigheden om in gesprek te komen met de leidinggevende en gezamenlijk oplossingen te zoeken.Zelfreflectie als voorbereiding op de acties is belangrijk; door dit leerproces wordt de werknemer ‘sterker’.De participatieve werkmethode is een programma voor de al dan niet verzuimende werknemer en zijn of haar leidinggevende met begeleiding door een onpartijdige procesbegeleider die zorgt voor een gelijkwaardige inbreng van beide partijen. Hoofddoel is het signaleren van belemmeringen en het bedenken van passende oplossingen op basis van consensus. Tot slot wordt, in geval van ziekteverzuim, een plan van aanpak voor werkhervatting opgesteld. Trainingen gericht op empowerment en de participatieve werkmethode lijken op veel terreinen en in diverse settings toepasbaar.

The Ethics of Biomedical Research. An International Perspective: Baruch A. Brody. Oxford University Press, New York, 1998. 386 pp.,

In this age of modern era, the use of internet must be maximized. Yeah, internet will help us very much not only for important thing but also for daily activities. Many people now, from any level can use internet. The sources of internet connection can also be enjoyed in many places. As one of the benefits is to get the on-line the ethics of biomedical research an international perspective book, as the world window, as many people suggest.