Generations and intention to leave current job : Belgian nurses in the workplace

This master thesis aims to identify work-related factors making Belgian nurses consider leaving their job voluntary and to compare the work-related factors across different generations. The purpose of this master thesis has a descriptive nature of research. The research approach chosen is a deductive approach and the research design chosen is a quantitative research design. Cluster sampling in combination with simple random sampling was used as sampling technique. 128 nurses were surveyed from April to May 2016. Nurses who reported to leave the organization due to retirement reasons, temporary employment contract or maternity leave were excluded from the study as this study investigates the voluntary turnover intention. A total of 68 nurses were included in the study which indicates an overall response rate of 53 %. Numerous of the findings in this master thesis are consistent with previous studies on turnover intention of different generations in other western-countries than Belgium. The work-related factor workload was most often reported by Belgian nurses with no intention to leave their job. Belgian nurses with an intention to leave their job indicated most often the work-related factor (non-)financial benefits. The generation-specific findings indicated both similarities and differences between the work-related factors selected. It was observed that Baby Boomers with an intention to leave their job selected most often variables related to the work-related factors (non-)financial benefits, supportive organization and workload. The variable lack of recognition appeared among Baby Boomers with an intention and no intention to leave their job. Surprisingly was the often selected variables lack of direct and/clear feedback on performances and unsupportive supervisor among Baby Boomers with professional turnover intention. Further, it was observed that Generation Xers with an intention to leave their job selected most often variables related to the work-related factors supportive organization, communication, (non-)financial benefits, work content and workload. The variables inadequate opportunity for advancement/professional growth and imbalance work-life appeared among Generation Xers with an intention and no intention to leave their job. Generation Yers with an intention to leave their job selected most frequently variables related to the work-related factors (non-)financial benefits, workload and commitment. The variables inadequate salary and opportunities elsewhere appeared among nurses with an intention and no intention to leave their job. Surprisingly was the often selected variable inadequate salary among Generation Yers with professional turnover intention.

The quality of the physical environment and its association with activities and well-being among older people in residential care facilities

The physical environment can influence older people’s health and well-being, and is often mentioned as being an important factor for person-centred care. Due to high levels of frail health, many older people spend a majority of their time within care facilities and depend on the physical environment for support in their daily life. However, the quality of the physical environment is rarely evaluated, and knowledge is sparse in terms of how well the environment meets the needs of older people. This is partly due to the lack of valid and reliable instruments that could provide important information on environmental quality. Aim: The aim of this thesis was to study the quality of the physical environment in Swedish care facilities for older people, and how it relates to residents’ activities and well-being. Methods: The thesis comprises four papers where both qualitative and quantitative methods were used. Study I involved the translation and adaptation of the Sheffield Care Environment Assessment Matrix (SCEAM) into a Swedish version (S-SCEAM). Several methods were used including forward and backward translation, test of validity via expert consultation and reliability tests. In Study II, S-SCEAM was used to assess the quality of the environment, and descriptive data were collected from 20 purposively sampled residential care facilities (RCFs). Study III was a comparative case study conducted at two RCFs using observations, interviews and S-SCEAM to examine how the physical environment relates to older people’s activities and interactions. In study IV, multilevel modeling was used to determine the association between the quality of the physical environment and the psychological and social well-being of older people living in RCFs. The data in the thesis were analysed using qualitative content analysis, and descriptive, bivariate and multilevel statistics. Results: A specific result was the production of the Swedish version of SCEAM. The instrument contains 210 items structured into eight domains reflecting the needs of older people. When using S-SCEAM, the results showed a substantial variation in the quality of the physical environment between and within RCFs. In general, private apartments and dining areas had high quality, whereas overall building layout and outdoor areas had lower quality. Also, older people’s safety was supported in the majority of facilities, whereas cognitive support and privacy had lower quality. Further, the results showed that environmental quality in terms of cognitive support was associated with residents’ social well-being. Specific environmental features, such as building design and space size, were also noted, through observation, as influencing residents’ activities, and several barriers were found that seemed to restrict residents’ full use of the environment. Conclusions: This thesis contributes to the growing evidence-based design field. The S-SCEAM can be used in future research on the association between the environment and people’s health and well-being. The instrument could also serve as a guide in the planning and design process of new RCFs.

Patients' experiences of support for learning to live with diabetes to promote health and well-being : A lifeworld phenomenological study

Learning to live with diabetes in such a way that the new conditions will be a normal and natural part of life imposes requirements on the person living with diabetes. Previous studies have shown that there is no clear picture of what and how the learning that would allow persons to incorporate the illness into their everyday life will be supported. The aim of this study is to describe the phenomenon of support for learning to live with diabetes to promote health and well-being, from the patient's perspective. Data were collected by interviews with patients living with type 1 or type 2 diabetes. The interviews were analysed using a reflective lifeworld approach. The results show that reflection plays a central role for patients with diabetes in achieving a new understanding of the health process, and awareness of their own responsibility was found to be the key factor for such a reflection. The constituents are responsibility creating curiosity and willpower, openness enabling support, technology verifying bodily feelings, a permissive climate providing for participation and exchanging experiences with others. The study concludes that the challenge for caregivers is to create interactions in an open learning climate that initiates and supports reflection to promote health and well-being.