Logo: to the web site of Uppsala University

Objective: To investigate job insecurity and symptoms of depression in different labour market groups, with a specific focus on young women.

Methods: Data were drawn from six waves of the Swedish Longitudinal Occupational Survey of Health (n = 14,827) in 2010–2020. Differences in job insecurity between young (≤ 35) working women and other gender and age (> 35) groups, and between labour market industries with different gender composition, were estimated. Longitudinal multilevel structural equation models were fitted to estimate reciprocal associations between job insecurity and depressive symptoms two years later, while adjusting for demographic and employment factors.

Results: Younger workers reported significantly higher job insecurity compared with older. For older workers job insecurity was significantly lower in female dominated industries, whereas this pattern was not observed among younger workers. There was a medium strong path between job insecurity and depressive symptoms in young working women (0.106, p = 0.001), and men (0.111, p = 0.011). The reverse associations were not statistically significant. For older women and men, the effect sizes for associations between job insecurity and depression were small (0.044, p = 0.000 and 0.047, p = 0.000, respectively) whereas reverse paths estimates were of medium strength (0.077, p = 0.000 and 0.109, p = 0.000).

Conclusion: The results indicated a clear age-related pattern. Higher levels of job insecurity and a stronger association between job insecurity and depressive symptoms were found among younger compared with older workers. No gender differences were observed. The results highlight the importance of addressing job insecurity as a concern in early working life.

Aims: To investigate predictors and common mental disorder outcomes of subjective social status in different gender and age groups of Swedish employees.

Methods: Data from eight waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH), collected between 2006 and 2020, were used (n=12,925). Fixed effects models were used to investigate whether changes in demographic and socioeconomic factors predicted changes in subjective social status and whether changes in subjective social status, in turn, affected symptoms of depression and sleep disturbances. The analyses were stratified by gender (female/male) and age (21–35/36–50 years).

Results: Across groups, the most consistent predictors of changes in subjective social status were being promoted during the past two years and a change in occupational status. An increase in subjective social status was associated with a decrease in symptoms of depression among women in both age groups and among men in the older age group. The association was stronger in younger women than in older women (p=0.042). For both women and men in the older age group, an increase in subjective social status was associated with a decrease in symptoms of sleep disturbances.

Conclusions: Occupational level was the most important predictor of subjective social status across groups, and subjective social status predicted common mental disorder, even after adjusting for socioeconomic status indicators. Changes in subjective social status affected young working women’s depressive symptoms in particular, while older workers showed an association between subjective social status and symptoms of sleep disturbances.

Background: Mental ill-health has increased among young people in Sweden in recent years, particularly among young women. One contributing factor could be a striving for high social status, communicated around the clock on social media platforms. The aim of the study was to explore how young working women in Sweden perceive social status and how it relates to their own health and well-being.

Methods: The study sample included 15 women aged 25–35 years, recruited from the Swedish Longitudinal Occupational Survey of Health, a cohort derived from a representative sample of the Swedish working population. Maximum variation purposeful sampling was employed to achieve rich information in the data. Data were collected through individual semi-structured interviews and analysed using thematic analysis.

Results: The analysis identified two main themes. The first theme, the qualities and processes of subjective social status, consisted of the subthemes material and personal resources and interpersonal and contextual interplay, and described aspects affecting social status, such as income, gender, and social life, as well as processes such as external influence and comparison. The second theme, the influence of subjective social status on health and well-being consisted of the subthemes being judged by oneself and others and strategies to reduce negative impact, and encompassed emotional responses to social status and approaches and attitudes to regulate its impact.

Conclusions: The results indicate that subjective social status in young working women today is established through dynamic and interactive processes involving several important aspects beyond traditional socioeconomic measures. The findings regarding the impact of gender and foreign background on subjective social status suggest a need for continued efforts to strengthen equality and integration in Swedish society. The impact of processes around establishing and displaying subjective social status on well-being and health appears to vary, depending on each individual's approach and active management of, e.g., social media.

Aims and objectives To describe strategies employed by registered nurses for handling difficult calls to emergency medical dispatch centres.

Background At emergency medical dispatch centres, registered nurses encounter a range of difficult calls in their clinical practice. They often use clinical decision support systems, but these may be of limited help if the caller is for instance abusive or has limited language proficiency. Much can be learnt from strategies developed by registered nurses for handling difficult calls.

Design A descriptive qualitative study was conducted.

Methods A purposeful sample of 24 registered nurses from three different emergency medical dispatch centres were interviewed. The transcribed interviews were analysed using qualitative content analysis. The COREQ checklist was applied.

Results An overarching theme was established: "Using one's nursing competence and available resources for a safe outcome", based on three sub-themes: Use one's own professional and personal resources, Use resources within the organisation and Use external resources. The themes in turn consist of ten categories.

Conclusions Registered nurses employed a range of strategies to deal with difficult calls, often in combination. They used their personal resources, resources within their own organisation, and collaboration partners to make safe triage decisions and use resources wisely. The effectiveness of these strategies, however, remains unknown. When registered nurses were unable to rule out a high-acuity condition, they used safety-netting and sent an ambulance. Evaluating current strategies and making strategies explicit could further improve the ability of nurses to handle difficult calls.

Relevance to clinical practice The strategies described by registered nurses for handling difficult calls to EMDCs included using a consecutive set of strategies. Some of the strategies seemed to be used deliberately, while others seemed tacit and applied in a routinised way. These strategies could potentially be useful for RNs working with telephone triage in different contexts.

Non-urgent and urgent telephone nursing services are increasing globally, and phenomenographic research has shown that how work is understood may influence work performance. This descriptive study makes a qualitative inductive investigation of understandings of emergency medical dispatch center work among registered nurses. Twenty-four registered nurses at three mid Swedish emergency medical dispatch centers were interviewed. Analysis based on phenomenographic principles identified five categories in the interviews: (i) Assess, prioritize, direct, or refer; (ii) Facilitate ambulance nursing work; (iii) Perform nursing care; (iv) Always be available for the public; and (v) Have the person behind the patient in mind. The first constitutes the basis of the work. The second emphasizes cooperation with and support for the ambulance staff. The third entails remotely providing nursing care, whilst the fourth stresses serving the entire population. The fifth and most comprehensive way of understanding work involves having a holistic view of the person in need, including person-centered care. Provision of high-quality emergency medical dispatch center work involves all categories. Combined, they constitute a "work map," valuable for reflection, competence development, and introduction of new staff.

Background Telephone triage at emergency medical dispatch centres is often challenging for registered nurses due to lack of visual cues, lack of knowledge about the patient, and time pressure - and making the right decision can be a matter of life and death. Some calls may be more difficult to handle, and more knowledge is needed about these calls to develop education and coping strategies. Therefore, the aim of this study was to describe the perspectives of registered nurses' views about managing difficult calls to emergency medical dispatch centres. Methods A descriptive design with a qualitative inductive approach was used. Three dispatch centers in mid-Sweden were investigated, covering about 950,000 inhabitants and handling around 114,000 calls per year. Individual interviews were carried out with a purposeful sample of 24 registered nurses. Systematic text condensation was conducted. Results Seven themes were generated: calls with communication barriers, calls from agitated or rude callers, calls about psychiatric illness, calls from third parties, calls about rare or unclear situations, calls with unknown addresses and calls regarding immediate life-threatening conditions. There was a strong consensus among the registered nurses about which calls were experienced as difficult, with the exception of calls about immediate life-threatening conditions. Some registered nurses thought calls about immediate life-threatening conditions were easy to handle as they simply adhered to protocol, while others described these calls as difficult and were emotionally affected. Conclusion The registered nurses' descriptions of difficult calls focused on the callers, while their own role, the organisational framework, and leadership were not mentioned. Many types of calls included difficulties, which could be related to the caller, their symptoms, or different circumstances. The registered nurses pointed to language barriers and rude, agitated callers as increasing problems. An investigation of actual emergency calls is warranted to examine the extent and nature of such calls.

Objectives

To describe how Registered Nurses make use of a Clinical Decision Support System to triage calls to emergency medical dispatch centres, from the perspective of professional autonomy.DesignThe study had a descriptive design with a qualitative inductive approach.

Methods

Interviews were done with 24 Registered Nurses during 2018–2019. Thematic analysis was conducted.

Results

Five themes and 16 subthemes were established: (a) Using the CDSS as a general support to professional competence in emergency calls, including subthemes: Support for professional competence, an aid to reflection, a compulsory support; (b) A specific support useful in difficult situations and calls, with subthemes: RN being tired or stressed out; vague and unclear symptoms, rare situations, aggressive and agitated callers; (c) Using the CDSS but changing triage recommendations/priority, including subthemes: Recommending a higher priority than the CDSS and recommending a lower priority than the CDSS; (d) Development areas for better use of the CDSS in collaboration with other services, with subthemes: Request for common documentation system with ambulances and closer collaboration with the national telephone nursing helpline; and (e) Possible technical development areas in the CDSS for optimal use, including subthemes: image transfer, medical records, development of certain areas in the CDSS, update of maps, a need for more knowledge.

Conclusion

The CDSS was not perceived as a restriction on professional autonomy. It was particularly useful in rare situations. Technical improvements as well as education and training should be done in close collaboration with registered nurses.

Impact

The study contributes with knowledge about how registered nurses triaging emergency calls use a decision support system. The system was a support for professional competence and did not seem to restrict them. The findings could be useful for clinicians and researchers in development of telephone triage and decision support systems.

BACKGROUND: Resident satisfaction is an important aspect of nursing home quality. Despite this, few studies have systematically investigated what aspects of nursing home care are most strongly associated with satisfaction. In Sweden, a large number of processual and structural measures are collected to describe the quality of nursing home care, though the impact of these measures on outcomes including resident satisfaction is poorly understood.

METHODS: A cross-sectional analysis of data collected in two nationally representative surveys of Swedish eldercare quality using multi-level models to account for geographic differences.

RESULTS: Of the factors examined, nursing home size was found to be the most important predictor of resident satisfaction, followed by the amount of exercise and activities offered by the nursing home. Measures of individualized care processes, ownership status, staffing ratios, and staff education levels were also weakly associated with resident satisfaction. Contrary to previous research, we found no clear differences between processual and structural variables in terms of their association with resident satisfaction.

CONCLUSIONS: The results suggest that of the investigated aspects of nursing home care, the size of the nursing home and the amount activities offered to residents were the strongest predictors of satisfaction. Investigation of the mechanisms behind the higher levels of satisfaction found at smaller nursing homes may be a fruitful avenue for further research.