Den gode jobsamtale
-
Upload
victoria-rosa -
Category
Documents
-
view
225 -
download
3
description
Transcript of Den gode jobsamtale
![Page 1: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/1.jpg)
Arbejde og stress.Nye udviklingstendenser i en
globaliseret økonomi
Den 2. stressforskningskonference7-11-2005
SIF
Tage Søndergård Kristensen
![Page 2: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/2.jpg)
The new challengesOutsourcing, downsizing, privatization,
precarious work, job insecurity
![Page 3: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/3.jpg)
Blood pressure and pulse amongNorwegian metal workers
80
90
100
110
120
130
140
150
160
1982 1983 1984 1985 1986 1987 1988586062646668707274767880
Erikssen et al. Tidsskr Nor Laegeforen. 1990;110:2873-7.
BP (mm Hg)(N = approx. 180)Threat of closure Pulse
SBP
Pulse
DBP
129 129130135
142 145 143
63 63
6970
84 85 8690
94 9691
![Page 4: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/4.jpg)
Hospital admissions for CVD in a group of unemployed men compared with a control group
Iversen et al. BMJ 1989;299:1073-6.
00,20,40,6
0,81
1,2
1,41,6
1,8
0.80
1.04
1.60
Before factoryclosure
(2 years)
During factoryclosure
(3 years)
After factoryclosure
(3 years)
0
1.81.61.41.2
10.80.6
0.40.2
![Page 5: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/5.jpg)
0
1
2New cases of ischemia*
Threats to employment security among white-collar workers in Whitehall
A five-year follow-up studyN=8354
1.0
1.401.60
1.45
Controldepartments
RR
Men Women TotalDepartment under privatization
*ECG or angina
Ferrie et al. AJPH 1998;88:1030-1036.
![Page 6: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/6.jpg)
Organisational downsizing and mortality
A 7.5 years’ follow-up study of 22.430 public employeeswho kept their jobs.
0
1
2
1.0
1.5
1.01.2
2.0
1.2
RR*
None Minor Major None Minor Major
Extent of downsizing
2.0
1.0
0
CVD Otherdeaths
Vahtera et al. BMJ 2004;328:555-558.
*Controlled for age, gender, SES, occupation
![Page 7: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/7.jpg)
Impact of work-related events immediatelybefore myocardial infarction
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
No Yes No Yes
1.0
2.0
3.0
4.0
5.0
6.06.0
Relative risk
Möller et al. JECH 2005;59:23-30
A case-crossover study of 660 cases
1.0 1.0
6.0
High pressure deadline Pressure from competition
Last day Last week
![Page 8: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/8.jpg)
A simple model
Job insecurity, downsizing, outsourcing, privatization
Loss of control, loss of social support, loss of meaning, loss of predictability,
loss of rewards
Stress, uncertainty, hopelessness,low self esteem
![Page 9: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/9.jpg)
The new fatigue
![Page 10: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/10.jpg)
The development of four different symptoms in the adult Swedish population 1986 - 2001
PercentFatigue
Back trouble
Sleep trouble
Distress
Gustafsson & Lundberg, eds. Arbetsliv och hälsa, 2004.
![Page 11: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/11.jpg)
05
101520253035404550
Work-relatedburnout
Work-related burnout and sleeping problemstwo years later
Results from the PUMA baseline and 2 years’ follow-up
N = 1014; Data from NIOH, Denmark
25.1
32.6 34.4
44.6
Low HighQuartiles
Karolinska sleepquestionnaire (scale)
![Page 12: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/12.jpg)
Burnout as predictor of ischaemic heart diseas
A 4.2 years’ follow-up study of 3,877 Dutch male employees from Rotterdam
”Have you ever been burned out?” No 74%Yes 26%
0
1
2
3
Burnout
* Controlled for age, BP, smoking, cholesterol. 59 cases.
Appels & Schouten. Behav Med 1991;Summer:53-59
1
2.13
No Yes
2
1
0
RR* for IHD*
![Page 13: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/13.jpg)
Exhaustion and CHD
A 9.5 years’ follow-up study of 3,365 Dutch men.
0
10
20
30
40
50
2630
4550
40
30
20
10
0None Medium High
Degree of exhaustion by the end of the working day.
Cases per 1000
Appels & Otten. Br J Clin Psychol 1992;31:351-356
![Page 14: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/14.jpg)
Vital exhaustion, IHD and death
6 years of follow-up of 9,563 adults from Copenhagen
* Adjusted for 13 biological, behavioural and social factors
Prescott et al. Int J Epidemiol 2003;32:990-7
Vital exhaustion0
1
2
3
0 1-4 5-9 10+
IHD
Mortality
1 1.1
1.6 1.8
1.2
2.2
1.6
3
2
1
0 1-4 5-9 10+0
RR*
![Page 15: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/15.jpg)
Sleep quality and myocardial infarction
3 years of follow-up of 416 middle-aged German blue-collar workers
Siegrist. J Chron Dis 1987;40:571-578.
0
1
2
3
4
RR
1.0
3.8
1.0
2.6
No NoYes YesWake up early Difficulty
staying asleep
![Page 16: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/16.jpg)
Psychological risk factors for CHD among homemakers from Framingham
*Adjusted for CVD risk factors.
Eaker et al. Am J Epidemiol 1992;135:854-864.
A 20-year follow-up study of 362 women
0
1
2
3
4
5
6
7
8
1.0
7.8RR *
6.2
3.9
1.0
876543210
- + - + - +
1.0
Tension Symptomsof anxiety
Troublefallingasleep
![Page 17: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/17.jpg)
Sleep and risk of IHD
A study of 71,617 American nurses followed for 10 years
Ayas et al. Arch Intern Med 2003;163:205-9
0,0
0,5
1,0
1,5
2,0
2,5
1.8
1.31.1 1.0
-5
RR
1.61.4
1.2 1.1 1.0
1.4
6 7 8 9+ - 5 6 7 8 9+
Adjusted for 14 factorsAge-adjusted
The Nurses’ Health Study
![Page 18: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/18.jpg)
0
1
2
3
4RR
CVD, sleep quality and ”need for recovery” after work
N=7,944 workers. 18-65 years. 42 cases.Van Amelsvoort et al. Occup Environ Med 2003;60:83-87.
Sleep quality Need for recovery
Results from 32 months of follow-up of the Maastrict Cohort Study on fatigue
3
2
1
0
1 11.22
3.162.82
Good Poor Low Medium High
![Page 19: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/19.jpg)
0
1
2
RR*
Long working hours and short sleep as risk factors for AMI
*Adjusted for smoking, alcohol, BMI, BP, DM, cholesterol, heart disease in family, job type and sedentary job
Lin er al. Occup Environ Med 2002;59:447-51.
Working hours/weekpast year
Days/week with <5 hours of sleep
A case control study of working Japanese men 40-79 years of age260 cases and 445 matched healthy controls
<40 41-60 61+ 0 1 2+
11.3
1.8
1 1.1
2.1
![Page 20: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/20.jpg)
Depression and CHDA meta-analysis
RR
Clinical depression 2.69 (1.63-4.43)
Depressive mood 1.49 (1.16-1.92)
Overall estimate 1.64 (1.29-2.08)
Rugulies. Am J Prev Med 2002;23:51-61.
Relative risk among initially healthy subjects.
Analysis of 11 studies
![Page 21: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/21.jpg)
The new fatigue
Long workinghours
Shift work,24 h society
Family/work
conflict
High emotionaldemands
High workpace
Conflicts,bullying
Fatigue
Burnout Need forrecovery
Withdrawal Depression
Sleep problems
Cardiovasculardisease
Stress
![Page 22: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/22.jpg)
Burnout and engagement – two sides of the same coin?
After Schaufeli et al.
Hard core business
Withdrawal/cynicism
Burnout Tired idealist
Dedication
Engagement
Exhaustion
Vigor
![Page 23: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/23.jpg)
Family and private life
![Page 24: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/24.jpg)
Work-family (im)balance
Do you experience a conflict between work and family, so that you feel you should be ”both places at thesame time”?
Yes, often 7%Yes, regularly 29%
Does your work take too much of your energy so thatyour private life suffers?
Yes, certainly 10%Yes, to some degree 34%
N=3517 Danish employees. 2005.
![Page 25: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/25.jpg)
Stress at work and in the family of American men
The proportion who got a divorce during 9 years
N = 10,904 married men in the MRFIT study
Matthews & Gump. Arch Intern Med 2002;162:309-15.
0
10
20
30
0 1 2 3+
%
6.5%8.2%
11.9%
19.7%
Numberof work stressors
DK-2004-001
![Page 26: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/26.jpg)
0
1
2
0 1 2 3+0
1
2
Still married Separaret Divorced
RR* RR*
Work stress Family stress
Stress and CVD mortality among American middle-aged men
9 years’ follow-up of 12,336 men in the MRFIT
*Controlled for eight important confounders.
Matthews & Gump. Arch Intern Med 2002;162:309-15. ENG-2004-001
1.00 1.07 1.191.34
1.00
1.43 1.40
Number of work stressors Events among married men
![Page 27: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/27.jpg)
Is marriage worse than work?(For women)
0
1
2
3
0
1
2
3
* Adjusted for age, diagnosis, SBP, DM, smoking, lipids and estrogen status.
Orth-Gomér et al. JAMA 2000;284:3008-14.
A follow-up study of 292 female heart patients in Stockholm
Low Moderate Severe
1
2.8 2.9
2
1
0
RR* For new events
Low Moderate Severe
11.3 (NS)
1.7 (NS)2
1
0
RR* For new events
Marital Stress Work stress
![Page 28: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/28.jpg)
0
1
2
None
Some
Perman
ent
None
Some
Perman
ent
LowM
oder
ateSe
vere
None
OneTwo o
r mor
e
RR*
Psychosocial factors and acute myocardial infarction: TheINTERHEART STUDY
Work stress Home stress Financial stress Life events
Rosengren et al. www.the lancet.com Sept. 3,2004:1-10
11,119 cases and 13,648 controls from 52 countries
2
1
0
1
1.38
1
2.14 2.12
1.52
11.19
1.33
11.23
1.48
![Page 29: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/29.jpg)
Work and product quality –is there an association?
![Page 30: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/30.jpg)
The Sirdal model for work environment and output quality
Output quality
Work environment Health and well-being of the employees
Client satisfaction and competence
Programs forimprovement
of work environ-ment and output
quality
![Page 31: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/31.jpg)
![Page 32: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/32.jpg)
Stress level amongthe nurses and patient incidents
0,0
1,0
2,0
3,0
0 - 4 4 - 5 5 - 5.5 5.5 - 6 6 - 6.5 6.5 - 7 7 - 10
A study of 293 nurses over 3 months
Average stress score (VAS scale) in 48 units
%
Patient incidents (falls, medication errors, other errors)
0.6
1.0 1.1
1.61.8
2.1 2.2
1.0
2.0
Dugan et al. J Nurs Care Qual 1996;10:46-58
![Page 33: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/33.jpg)
Association between burnout leveland critical incidents
A study of 678 Japanese nurses at Tokyo University Hospital
Level of burnout
Low High1 2 3 4 Total
Falling patient 29% 38% 45% 51% 41%
Mistakes related to transfusions 2% 4% 7% 9% 6%
Mistakes related to medication 41% 53% 52% 62% 53%
Mistakes related to operations/anaesthesia 9% 2% 3% 3% 4%
P< 0.05
Odagiri, Kristensen & Shimomitsu, 2005
![Page 34: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/34.jpg)
Staff workload and hospital mortality
0
1
2
3
4
1.0
2.0 1.9
3.1
Low Medium High
A 4-year study in an adult intensive care unit (337 hospital deaths)
1.0
2.0
3.0
Tarnow-Mordi et al. Lancet 2000;356:185-189
Overall workload
Relative risk for death
![Page 35: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/35.jpg)
Patient-to-nurse ratio: Possibleconsequences for nurses and patients
0
0,5
1
1,5
2
0.5
1.0
1.5
Aiken et al. JAMA 2002;288:1987-1993
An American study including 10,184 nurses, 232,342 patients, and 168 hospitals
High burnout Job dissatisfaction Patient mortality Failure to rescue
Relative risk*
1.0
1.23
1.0
1.15
1.01.07
1.01.07
NURSES PATIENTS
* RR associated with an increase of 1 patient per nurse. Adjusted.
![Page 36: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/36.jpg)
Errors in patient treatment beforeand after a stress management
programme
Errors per hospital per yearYear before Year after
Control hospitals 1,64 1,59Intervention hospitals 1,41 0,41*
22 hospitals in each group.Matched on three criteria.* p<0,01
Jones et al. J Applied Psychol 1998;73:727-735.
![Page 37: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/37.jpg)
The effect of a stress management programme for theincidence of medical treatment errors
Jones et al: J Applied Psychol 1988;73:727-353
![Page 38: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/38.jpg)
Many challenges – one solution?
• The globalized economy• Competitiveness of private business• Quality of the public services• The new fatigue• Family-work conflict
- and the ”golden nuggets” of psychosocial work environment and private life: influence, meaning, support, predictability, rewards, demands
![Page 39: Den gode jobsamtale](https://reader030.fdocuments.in/reader030/viewer/2022020106/568bd9911a28ab2034a78542/html5/thumbnails/39.jpg)
The End
www.ami.dk/presentations
This presentation (and many others)may be found at