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AIM: To investigate the relationship between nurses' climate of perceived organizational support, and their well-being and healthcare-unit performance. DESIGN: A two-wave cohort questionnaire study among nurses within six hospitals in Sweden. METHODS: Hypotheses were tested using cross-lagged path models on the individual (organizational support, job satisfaction, burnout, intention to stay) and aggregate levels (care-unit organizational support, team effectiveness, patient safety climate and patient safety). Analyses were based on 1.817 nurses in 228 care-units (T1), 1.362 nurses in 213 care-units (T2) and longitudinal samples of 711 nurses and 140 care-units. RESULTS: Organizational support (T1) positively influenced job satisfaction (T2) and tended to decrease burnout (T2) but did not affect turnover intent. Reversed relationships were also found. No statistically significant prospective effects were found on the aggregate level. CONCLUSION: The results indicated a prospective reciprocally reinforcing relationship between organizational support and job satisfaction. Burnout and intention to stay were predictors rather than outcomes of the organizational support climate. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: A climate where nurses perceive that their organization values their contributions and cares about their well-being is beneficial for their job satisfaction and health, which, according to previous research, may influence nurse retention. IMPACT: The study addressed perceived organizational support as a potential predictor of nurses' well-being and healthcare-unit performance. A mutually reinforcing relation was indicated between organizational support and nurses' job satisfaction and health. Job dissatisfaction, burnout symptoms and turnover intentions were prospectively negatively related to the organizational support. Identifying and implementing a variety of practical measures to support perceptions of organizational support may be an effective way for healthcare management to start and sustain the development of a healthier work environment for healthcare professionals. REPORTING METHOD: STROBE statement for cohort studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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OBJECTIVE: The aim of the present study was to investigate the longitudinal relationships between nurses' organizational climate of perceived organizational support (POS-climate) and their psychosocial working conditions and psychological contracts. METHODS: A two-wave longitudinal cohort questionnaire study was carried out among registered nurses employed within six hospitals in two regions in Sweden (n = 711). Two cross-lagged panel models were tested after ensuring scalar factorial invariance of the measurement models. The first model investigated longitudinal relationships between psychosocial working conditions and the POS-climate, while the second model investigated such relationships between the psychological contracts and the POS-climate. RESULTS: The results indicated that influence at work and an ideology-infused psychological contract had positive effects on the nurses' POS-climate. CONCLUSIONS: These results highlight the importance of providing nurses with such influence, and of a shared ideology within the entire health-care organization, centered on the ethical values of the health-care professions.

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BACKGROUND: Transition programs for newly graduated nurses in hospital settings are reported to provide learning opportunities, strengthening confidence, workplace integration and skills, retention and job satisfaction. Still, our knowledge of long-term effects is scarce and few studies have used control groups. OBJECTIVE: To explore the long-term impact of having attended a transition program on the nurses' experiences of the first years of practice. More specifically, ideology-infused psychological contract, ethical stress, perceived organizational support, job satisfaction, opportunities for learning, and intention to stay in the nursing profession, were explored as outcome variables. METHODS: A questionnaire survey was carried out among registered nurses from November 2019 to January 2020, with a 54% response rate. The analysis was based on 149 nurses who had attended a transition program, and 72 who had not attended. The nurses had seniority between one and three years. Independent samples t-test were used to investigate differences between the groups. RESULTS: The two groups showed small and non-significant differences in the outcome variables. However, regarding the frequency of ethical value conflicts induced by insufficient resources, as well as experiences of ethical value conflict distress, the group of nurses who had attended a transition program showed statistically significantly higher mean values, although the effect sizes were small. CONCLUSION: Newly graduated nurses need more than transition programs and skills training to progress in their nursing role and develop competence, increase job satisfaction, and reduce stress. Achieving these goals requires a long-term supportive learning environment that is integrated into everyday work.

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OBJECTIVE: Moral distress emanating from value conflicts comprising ethical dimensions pose a threat to nurses' health and retention, as well as to the quality of care. The aim of the present study was to investigate the relationships between the frequency of ethical value conflicts (EVC), and the perceived distress when they occur, respectively, and nurses' work-related stress, burnout symptoms, turnover intent, team effectiveness, and patient safety. METHODS: A two-wave longitudinal cohort questionnaire study was performed among registered nurses at six hospitals in two Swedish regions. Cross-sectional analyses (T1) were based on 1817 nurses in 228 care units (CU), and longitudinal analyses (T1 - T2) on 965 nurses in 190 CU. Hypothesis testing was performed using multilevel controlled regression modeling. RESULTS: The results indicated that nurses who were often exposed to EVC also to a higher extent tended to report these conflicts as stressful. Frequent exposure to EVC induced by insufficient resources, inapt organizational structures or interpersonal staff relations were cross-sectionally associated with work-related stress, burnout symptoms, turnover intent, and team effectiveness. The longitudinal analyses indicated that EVC induced by a lack of resources primarily had negative effects on nurses' health and well-being. At the CU level, such conflicts also impaired team effectiveness. At the individual level, EVC induced by organizational constraints or interpersonal relations negatively affected care effectiveness. CONCLUSIONS: EVC are related to negative consequences in healthcare, and such processes take place both on the individual and organizational levels.

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AIM: To explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts. DESIGN: A mixed methods design with a longitudinal questionnaire survey and focus group interviews. METHODS: A questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November-January 2019/2020 and November-January 2020/2021). A cross-lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April-October 2021). Qualitative data collection and analysis were inspired by Grounded Theory. RESULTS: A climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur. CONCLUSION: It is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve. IMPLICATIONS FOR THE PROFESSION: By ensuring a shared care ideology, good inter-professional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful. IMPACT: The study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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BACKGROUND: The construction industry is heavily affected by occupational accidents, and it is important to investigate how leadership behaviors promoting safety on construction sites are fostered among construction-site managers. OBJECTIVE: The overall aim of this study was to investigate how safety-leadership behaviors can be developed in the construction industry, specifically focusing on managerial role modeling. METHODS: A two-wave longitudinal cohort study with approximately four months between measurement occasions was conducted among construction-site supervisors in Sweden (n = 51). Supervisors' ratings of their site managers' and their own generic and safety-specific contingent reward (CR) leadership behaviors were obtained by means of questionnaires. Cross-lagged panel models were tested within a path model framework to test the hypothesis that site managers' leadership behaviors prospectively influence supervisors' leadership behaviors. RESULTS: Site managers' CR behaviors prospectively influenced supervisors' CR behaviors, both generic CR behaviors (ß= 0.29, p = 0.01) and safety-specific CR behaviors (ß= 0.22, p = 0.04). For safety-specific CR behaviors, a reversed effect (ß= 0.26, p = 0.03) was also found, implying that supervisors' behaviors prospectively influenced site managers' behaviors. CONCLUSION: Site managers act as role models for supervisors when it comes to developing safety-leadership behaviors on construction sites. The results also indicate that site managers are influenced by their subordinate supervisors' safety-leadership behaviors. Hence, there seems to be reciprocal interaction between site managers and supervisors in which they influence each other and together shape safety-leadership practices at their construction sites.

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INTRODUCTION: Construction site managers play a critical role in occupational safety in the construction industry. This study aimed to develop and test a method for training construction site managers in positive feedback and active listening by incorporating the behavioral training components of behavior analysis, goal setting, practice with behavior feedback, homework, and maintenance planning into individualized behavior-based safety-leadership training (IBST), and to assess the effect of IBST on construction site managers' safety-leadership behaviors and performance. METHOD: In a naturalistic randomized controlled trial, construction site managers were randomly assigned to an experimental group (n = 16) or a control group (n = 19). The experimental-group managers received IBST, while the control-group managers received no training. Paired sample t-tests on pre- to post-training (i.e., six weeks after the final training session) were performed separately for the experimental- and control-group managers. RESULTS: The safety-leadership behaviors of the experimental-group managers improved in terms of favorable feedback (d = 0.99, p <.01), safety-specific feedback (d = 0.89, p =.02), behavior-specific feedback (d = 0.66, p =.02), antecedent listening (d = 0.68, p =.02), and consequential listening (d = 0.78, p =.01). In addition, safety-leadership performance improved in terms of transformational leadership (d = 0.78, p =.01) and contingent-reward leadership (d = 0.64, p =.02). No significant change was found for the control-group managers. CONCLUSIONS: The results indicate that behavior analysis, goal setting, practice with behavior feedback, homework, and maintenance planning are effective behavioral training components of safety-leadership training. Positive feedback and active listening were also found to be important behavioral requisites for transformational and contingent-reward leadership. PRACTICAL APPLICATIONS: IBST can be used to develop occupational safety in the construction industry by improving construction site managers' safety-leadership behaviors and performance.

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AIM(S): This study aims to investigate care unit managers' perceptions of how the COVID-19 pandemic influenced their ability to support the nurses. BACKGROUND: The COVID-19 pandemic placed extreme pressure on health care organizations. More knowledge regarding how the pandemic influenced care unit managers' ability to support nurses is central to ensuring high-quality health care in future crises. METHOD(S): A mixed-methods study in Swedish hospitals with a survey (n = 128) and interviews (n = 20) with care unit managers. RESULTS: Approximately half of the managers reported having spent more time available to and supporting the nurses. Availability was positively predicted by their perceived organizational support while negatively by their job demands. These job demands concerned meeting staff anxiety and managing organizational restructuring. Full focus on direct patient care and strong professional and social support were important job resources. CONCLUSION(S): For care unit managers to effectively support the nurses during a crisis, they need proficient job resources and moderate job demands. Managers' perceived organizational support positively affects the quality of their crisis leadership. Creating arenas in which staff collegiality can form and develop is beneficial for the ability to meet future crises. IMPLICATIONS FOR NURSING MANAGEMENT: This study specifies important job resources that should be acknowledged and reinforced to strengthen the ability of care unit managers to actively support the nurses during a crisis.

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Healthcare unit managers are pivotal to promote nurses' Perceived Organizational Support and hence to ensure nurses' health and well-being, as well as high-quality care. Despite this fact, there is a dearth of studies addressing how healthcare unit managers act and organize their work to promote nurses' Perceived Organizational Support and which working conditions enable them to do so. Through a mixed methods approach, comprising qualitative interviews and quantitative surveys among healthcare unit managers and nurses, this paper underscores that healthcare unit managers' availability to their nursing staff was essential for their ability to promote nurses' Perceived Organizational Support, and that responsive support from the care unit managers' superior management, administration, and managerial colleagues constituted enabling working conditions. Superior manager support strongly promoted the care unit manager's own Perceived Organizational Support, which, in turn, was positively correlated with nurses' organizational climate of Perceived Organizational Support.

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INTRODUCTION: Patient safety climate/culture is attracting increasing research interest, but there is little research on its relation with organizational climates regarding other target domains. The aim of this study was to investigate the relationship between patient safety climate and occupational safety climate in healthcare. METHOD: The climates were assessed using two questionnaires: Hospital Survey on Patient Safety Culture and Nordic Occupational Safety Climate Questionnaire. The final sample consisted of 1154 nurses, 886 assistant nurses, and 324 physicians, organized in 150 work units, within hospitals (117units), primary healthcare (5units) and elderly care (28units) in western Sweden, which represented 56% of the original sample contacted. RESULTS: Within each type of safety climate, two global dimensions were confirmed in a higher order factor analysis; one with an external focus relative the own unit, and one with an internal focus. Two methods were used to estimate the covariation between the global climate dimensions, in order to minimize the influence of bias from common method variance. First multilevel analysis was used for partitioning variances and covariances in a within unit part (individual level) and a between unit part (unit level). Second, a split sample technique was used to calculate unit level correlations based on aggregated observations from different respondents. Both methods showed associations similar in strength between the patient safety climate and the occupational safety climate domains. CONCLUSIONS: The results indicated that patient safety climate and occupational safety climate are strongly positively related at the unit level, and that the same organizational processes may be important for the development of both types of organizational climate. PRACTICAL APPLICATIONS: Safety improvement interventions should not be separated in different organizational processes, but be planned so that both patient safety and staff safety are considered concomitantly.

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PURPOSE: Unfavorable psychosocial working conditions are hypothesized to lead to perceived stress, which, in turn, can be related to an increased risk of development of neck/shoulder symptoms through increased and sustained muscle activation. The aim of the present study was to test this hypothesized process model among medical secretaries, a female-dominated profession characterized by a high amount of visual display unit use and a high prevalence of neck/shoulder symptoms. METHODS: In this cross-sectional study, a questionnaire survey was conducted among medical secretaries (n = 200). The proposed process model was tested using a path model framework. RESULTS: The results indicate that high work demands were related to high perceived stress, which in turn was related to a high perceived muscle tension and neck/shoulder symptoms. Low influence at work was not related to perceived stress, but was directly related to a high perceived muscle tension. CONCLUSIONS: In general, these cross-sectional results lend tentative support for the hypothesis that adverse psychosocial work conditions (high work demands) may contribute to the development of neck/shoulder symptoms through the mechanism of stress-induced sustained muscular activation. This process model needs to be further tested in longitudinal studies.

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OBJECTIVE: The aim of this prospective study was to investigate the reciprocal nature of the physical activity-depressive symptoms relationship in 17,593 older adults from 11 European countries older adults (M age = 64.07, SD = 9.58) across two-year follow-up. Also, gender and age were examined as potential moderators of this relation. METHOD: A two-wave cross-lagged panel design and latent change score models with structural equation modeling was used to analyze data. Depressive symptoms were measured at baseline (T1) and follow-up (T2) using the EURO-D scale, capturing the two factors of affective suffering and motivation. Physical activity was measured at T1 and T2 as frequency of moderate physical activity and vigorous physical activity. RESULTS: Cross-sectional latent variable analyses revealed that higher levels of physical activity at T1 and T2 were associated with lower levels of affective suffering and motivation at T1 and T2. Physical activity at T1 was significantly associated with affective suffering and motivation at T2. The relations of depressive symptoms at T1 with physical activity at T2 were not significant. However, a cross-lagged model showed best model fit, supporting a reciprocal prospective relationship between physical activity and depressive symptoms in older adults. Latent change in depressive symptoms factors was related to latent change in physical activity indicating complex and dynamic associations across time. CONCLUSIONS: Regular physical activity may be a valuable tool in the prevention of future depressive symptoms in older adults, and depressive symptoms may also prevent older adults from engaging in regular physical activity.

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We evaluated the clinical effects of a myofeedback-based teletreatment service in terms of pain, pain-related disability and work ability. We also investigated the time investment/savings of this treatment with respect to conventional care. Sixty-five women with neck and shoulder pain at work participated in the study. Thirty-three took part in the teletreatment and 32 participated in a control group which continued with conventional care. Questionnaires were completed before the start of the intervention (baseline) and at initial follow-up (T0) and 3 months (T3) after the intervention ended. A general linear model analysis for repeated measurements showed an improvement in terms of pain and work ability for both groups taken together, with no differences between them. Non-parametric tests showed an intervention effect in pain-related disability for both groups together and no differences between them when tested at baseline, T0 and T3. The time saved in relation to conventional care was mainly from reduced travel time, which was 41 min per teleconsultation. The teletreatment service allowed employees to take part in muscle relaxation training while performing their regular work. The clinical evaluation showed that the treatment was on par with conventional care, but without the effort and time loss associated with regular visits to the clinic. We conclude that the myofeedback-based teletreatment service has potential for addressing neck and shoulder symptoms at the workplace.

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We investigated the potential prognostic factors for clinically relevant improvements in pain intensity and pain-related disability after myofeedback-based teletreatment. Sixty-five female computer users, 56 female patients with whiplash-associated disorders and 18 female patients with non-specific neck and shoulder pain participated in the study. They received myofeedback-based teletreatment or usual treatment. Questionnaires concerning prognostic factors, pain and disability were completed before the start of the intervention (baseline) and at follow-ups at the end of the intervention, and after 3 and 6 months. Logistic regression analyses were performed in order to investigate prognostic factors for clinically relevant improvement. In the intervention group, improvement in pain intensity was predicted by baseline pain intensity. Baseline pain intensity and disability, and fear-avoidance and endurance related pain coping responses were prognostic factors for outcome in pain-related disability in this group. There were few differences between the intervention groups; fear-avoidance coping responses influenced the outcome after teletreatment only. Myofeedback-based teletreatment appears to be an useful telemedicine intervention, especially for participants with moderate to high levels of pain and disability, high perceived help/hopelessness, and those who tend to deal with their pain by avoiding social and physical activities.

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INTRODUCTION: It has been suggested that treatments may be more effective when they are matched to patient characteristics. This study aimed at investigating potential prognostic factors for clinically relevant improvement in symptom intensity and symptom-related disability among employees with symptoms in the neck/shoulder area, receiving either ergonomics counseling or such counseling in combination with myofeedback training. METHODS: A randomized controlled study was performed among female computer users aged 45 or older (n = 36). A clinical examination and a questionnaire survey were performed before inclusion in the study. Symptom intensity and disability was assessed using questionnaires before the start of the interventions (baseline) and at follow-ups directly after the end of the interventions (T0) and after 3 (T3) and 6 (T6) months. Logistic regression analyses were performed in order to assess prognostic factors for clinically relevant improvement in symptom intensity and disability. RESULTS: Improvement in symptom intensity was consistently predicted by symptom intensity at baseline. Diagnosis and stress-induced lack of muscular rest were prognostic factors for improvement in symptom intensity at short term follow-up. Baseline disability and passive coping consistently served as prognostic factors for outcome in disability. Few substantial differences were found between the interventions in terms of prognostic factors. CONCLUSIONS: Myofeedback training in combination with ergonomics counseling seem to be an especially beneficial tool for secondary prevention among employees with moderate levels of symptom intensity and symptom-related disability, who respond to work-related stress by increased/sustained muscle activation, and who tend to employ passive coping to deal with their neck/shoulder symptoms.

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The aim of the present study was to test a path model of the relation between psychological workload and neck/shoulder symptoms with general fatigue as a proposed mediating variable. In this longitudinal two-wave cohort study a questionnaire survey was conducted among female childcare workers. The analyses were based on initially symptom free participants (n=388). Two models were tested, with fatigue at baseline and at follow-up as the proposed mediators, respectively. The results indicate that appraised psychological workload is related to the development of symptoms measured at an 18-month follow-up. The results further indicate that this relation may be partially mediated by general fatigue (also measured at follow-up). The findings of the present study emphasize the importance of the psychological workload in the development of neck/shoulder symptoms among childcare workers. This means that in addition to workplace ergonomic interventions it is important also to pay attention to the psychosocial conditions in order to reduce these symptoms.

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OBJECTIVES: Knowledge regarding the working mechanism of an intervention is essential for obtaining a better understanding of the intervention and contributes to optimize its outcome. This study aimed at investigating whether changes in cognitive-behavioral factors and muscle activation patterns after myofeedback training and ergonomic counseling were associated with outcome, in subjects with work-related musculoskeletal neck-shoulder complaints. METHODS: Seventy-nine symptomatic subjects received either myofeedback with ergonomic counseling (Mfb/EC) or ergonomic counseling alone (EC). Outcome measures discomfort and disability, and process factors catastrophizing, pain control, fear-avoidance beliefs, and muscle activation patterns were assessed at baseline, after the interventions (T0), and at 3 months follow-up (T3). Mixed modeling techniques were used for analysis. RESULTS: Outcome in terms of discomfort and disability was generally comparable between both interventions. Catastrophizing was significantly reduced and fear-avoidance beliefs about work slightly increased after the interventions, but no consistent changes in muscle activation patterns were observed. Changes in discomfort were especially associated with changes in catastrophizing at T0 and T3, but R(2) was low (<0.14). Reduced catastrophizing at T0 and T3, and also reduced fear-avoidance beliefs about work at T3, were related to reduced disability (R(2) between 0.30 and 0.40). No differences between the two intervention groups were observed. CONCLUSIONS: Intervention effects were generally non-specific and findings suggested that cognitive-behavioral factors underlie the outcome of these interventions rather than changes in muscle activation patterns. Emphasizing these factors during therapy may increase the beneficial outcome of occupational interventions.

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OBJECTIVE: To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability. METHODS: Seventy-nine female computer workers reporting neck-shoulder complaints were randomly assigned to Mfb or EC and received four weeks of intervention. Pain intensity in neck, shoulders, and upper back, and pain disability, were measured at baseline, immediately after intervention, and at three and six months follow-up. RESULTS: Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC, and the effects remained at follow up. No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability. CONCLUSIONS: Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up. No differences were observed between the two intervention groups.

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