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Insufficient competence among nursing staff is a major concern in elderly care worldwide as the healthcare needs of the elderly become increasingly complex. In previous research, insufficient competence has been associated with work dissatisfaction and stress among elderly care nurses, and with lower quality of care. This thesis describes the development, implementation and evaluation of an educational intervention for nursing staff in elderly care. In a prospective, controlled study, evaluation of the educational toolbox was based on nursing staff ratings of their competence and psychosocial work environment, as well as on care recipients’ and family relatives’ ratings of the quality of elderly care.

Paper I validated a questionnaire measuring care recipient relatives’ perceptions of quality of care. Paper II compared self-rated competence, work strain, stress, and work satisfaction between staff working in home-based care and nursing homes. Papers III and IV evaluated the impact of the educational intervention on staff perceptions of their competence and psychosocial work environment (Paper III) and on care recipients’ and relatives’ perceptions of the quality of care (Paper IV).

The results showed that staff ratings of their competence and psychosocial work environment, including work satisfaction and work stress, improved significantly over time in the intervention municipality, compared to the reference group. Neither care recipients’ nor relatives’ ratings of the quality of care changed significantly over time in the intervention organization. Furthermore, there were no significant interaction effects over time between the intervention and reference groups for quality ratings. These results indicate that an educational toolbox that can be used according to local workplace needs may be an effective and sustainable intervention for improving staff competence and the psychosocial work environment. However, further studies are needed to investigate whether, and under what conditions, improved staff competence and work environment have an impact on quality of care.