Tài liệu Registered nurses’ health in community elderly careinSweden ppt

Registered nurses’ health in community elderly careinSweden inr_984 409 415 K. Josefsson PHD, RNT Associate Professor, Senior Lecturer, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden JOSEFSSON K. (2012) Registered nurses’ health in community elderly care in Sweden. International Nursing Review 59, 409–415 Aim: To describe registered nurses’ (RNs) ratings of their work-related health problems, sickness presence and sickness absence in community care of older people. To describe RNs’ perceptions of time, competence and emotional pressure at work. To describe associations between time, knowledge and emotional pressure with RNs’ perceptions of work-related health problems, sickness presence and sickness absence. Background: There is a global nursing shortage. It is a challenge to provide working conditions that enable RNs to deliver quality nursing care. Method: A descriptive design and a structured questionnaire were used. 213 RNs in 60 care homes for older people participated, with a response rate of 62%. Findings: RNs’ reported work-related health problems, such as neck/back disorders, dry skin/dry mucous membranes, muscles/joints disorders, sleep disorders and headache. They had periods of fatigue/unhappiness/ sadness because of their work (37%). Most of the RNs felt at times psychologically exhausted after work, with difficulties leaving their thoughts of work behind. RNs stated high sickness presence (68%) and high sickness absence (63%). They perceived high time pressure, adequate competence and emotional pressure at work. There was a weak to moderate correlation between RNs’ health problems and time pressure. Discussion: We cannot afford a greater shortage of RNs in community care of older people. Politicians and employers need to develop a coordinated package of policies that provide a long-term and sustainable solution with healthy workplaces. Conclusion: It is important to prevent RNs’ work-related health problems and time pressure at work. Keywords: Community Elderly Care, Positive Practice Environments, Questionnaire, Registered Nurse, Time Pressure, Work-Related Health Problems Background Registered nurses (RNs) are key figures in the community care of older people (Josefsson 2006). However, there is a global nursing shortage, that is, an imbalance between demand for employment and the available supply (Oulton 2006). The factor contributing to increased demand is an ageing population, since ageing increases the risk for chronic illness and multimorbidity. By 2050, there will be a greater number of older people than younger ones in the world (Oulton 2006; United Nations 2009). Other reasons are unfavourable work environments that include excessive workloads, inadequate support staff, violence, stress, burnout, wage disparities and little involvement in decision making (Fronteira & Ferrinho 2011; Josefsson 2006; Lim et al. 2010; Oulton 2006). RNs’ working conditions must therefore be addressed in order to retain currently employed RNs, encourage new RNs to replace those that retire and prevent health problems for RNs (Eley et al. 2007). Correspondence address: Karin Josefsson, School of Health, Care and Social Welfare, Mälardalen University, Box 325, SE-63105 Eskilstuna, Sweden; Tel: +46-70-6689416; Fax: +46-16-153740; E-mail: karin.josefsson@yahoo.se. bs_bs_banner Nurses’ Work-Life Experiences © 2012 The Author. International Nursing Review © 2012 International Council of Nurses 409 RNs in community care of older people work under psycho- logical, emotional and time pressures (Josefsson et al. 2007; Lim et al. 2010) often without support in the form of organized supervision (Josefsson et al. 2008). Hallin & Danielson (2007a) found that RNs considered high time pressure a greater obstacle than difficult work tasks. Time pressure has been shown to occur frequently in association with burnout in healthcare workers (Stordeur et al. 2001). RNs also described their work as varying between stimulating and strenuous, leaning towards the latter (Hallin & Danielson 2007b). Moreover, RNs were frustrated since they were expected to ‘be everywhere and know everything’ (Karlsson et al. 2009). RNs also experienced themselves as ‘lone fixers’ giving rise to a highly stressful work situation and more complicated roles (Karlsson et al. 2009). Nursing is considered a risk profession with high levels of stress and burnout (Clegg 2001; Garrosa et al. 2008; Ilhan et al. 2008). Work-related stress in the care of older people has been reported on a worldwide scale (Eley et al. 2007; Hasson & Arnetz 2008; Josefsson et al. 2007). The negative effects of work-related stress on health have been extensively described (Garrosa et al. 2008; Ilhan et al. 2008; Karasek & Theorell 1990). One of the leading work stress models is the demand-control- support model (Karasek & Theorell 1990). The model aids in understanding the connection between work organization, expe- rienced stress and health (Josefsson et al. 2007; Tummers et al. 2002). An employee working with demands balanced by a feeling of high control and the possibility to utilize skills and knowledge leads to a stimulating work situation. On the other hand, the experience of high demands imbalanced by low control and no opportunities to utilize skills creates a highly stressful work situ- ation, which in the long run, can lead to work-related stress and unhealthy consequences. Josefsson et al. (2007) showed that RNs in community care of older people perceived a highly strenuous work situation characterized by high demands, such as high time pressure. Therefore, RNs in the long run, placed their mental health at risk. This could lead to sickness absence and (if other employment is available) high staff turnover (Karasek & Theorell 1990). In summary, community care of older people entails high risk for stressful work, which can predict health problems. However, there is a paucity of description of RNs’ perceptions of work- related health problems, sickness presence and sickness absence. As high work demands such as time, knowledge and emotional pressure, seem to be central to nursing work, these aspects will be studied as perceived by RNs, as well as associations between these demands and health. The current study defines sickness absence as being off work and sickness presence as being sick but on the job (Aronsson et al. 2000; Elstad & Vabö 2008). Aims To describe RNs’ ratings of their work-related health problems, sickness presence and sickness absence in community care of older people. To describe RNs’ perceptions of time, competence and emotional pressure at work. To describe associations between time, knowledge and emotional pressure with RNs’ per- ceptions of work-related health problems, sickness presence and sickness absence. Method Sample The healthcare system in Sweden consists of 20 county councils at a regional level and 290 communities at a local level [SALAR (The Swedish Association of Local Authorities and Regions) 2005]. The communities are responsible for residential care homes of older people. The target population consisted of 342 RNs who worked in 60 residential care homes with subunits in the care of older people, in a large community in Central Sweden. Of the subunits, 33 were in dementia care and 20 were in general elder care where RNs have to deal with a greater scope of various diagnoses. Seven residential care homes had subunits both for dementia care and general care. In total, n = 213 RNs participated in this study, which com- prised 62% of the target population. The RNs worked in direct care, not as nurse managers at any level of management. RNs had a median age of 51 years (min = 23, max = 76). The median of the year they qualified nursing examination was 1983 (min = 1956, max = 2002). The majority of RNs were female (93%). They had worked as RNs 18 years (median; min = 1, max = 51) and they had worked 2 years at their current work- place (min = 0.08, max = 40). They had worked 8 years as RN in elderly care (min = 0.17, max = 30). Most of the RNs were per- manently employed (86%). Twelve per cent of the RNs were employed on an hourly contract directly by the organization, and 4% were employed full-time by deputyship or project. To record the motives of non-respondents (n = 129), a form was distributed to them, and they were asked to respond to the following statement: ‘I have not answered the questionnaire because ’.Non-respondents’ reasons for not participating in the study were primarily lack of time, too extensive questionnaire and high workload. The questionnaire and development The questions were derived from a questionnaire developed by Aronsson et al. (1992) and previously used to gain information about the perceptions of staff about their work situation, own 410 K. Josefsson © 2012 The Author. International Nursing Review © 2012 International Council of Nurses health, sickness absence and sickness presence. The question- naire was designed for physicians in a variety of specializations and organizational structures. The questions were carefully selected to suit the aims of this study. Some questions were modified to apply more specifically to RNs as an occupational group in the care of older people, for example, years of experi- ence working as RNs and as RN in elderly care. The logistics of the questionnaire and the relevance of the questions were trialled at a seminar; see the procedure. Three main sections of the questionnaire were developed to meet the aims of this study. The first section asked for back- ground characteristics such as age, gender, number of active years as a RN and year of nursing qualifying examination. The second section consisted of questions that explored RNs’ percep- tions of work-related health problems, sickness absence and sick- ness presence. The questions were presented with a selection of response categories, which were rated in ordinal scales using a Likert-type scale, for example, of 1–5 ranged from ‘never’ to ‘most often’. The third section consisted of questions that explored RNs’ perceptions of time, knowledge and emotional pressure. The questions were presented with a selection of response categories, which were rated in ordinal scales using a Likert-type scale of 1–5 ranged from ‘absolutely too low’ to ‘abso- lutely too high’. The participants were given an opportunity to add their comments at the end of the questionnaire. Procedure The questionnaire was trialled at a seminar of RNs, psycholo- gists, physiotherapists, occupational therapists, lecturers and researchers who were all employed directly or indirectly in com- munity care of older people. The questionnaire was tested to assess the logistics and relevance of the questions, the clarity of interpretation and time needed to complete the questionnaire (Altman 1997). The questionnaire was also tested by 10 RNs. The RNs were given an autonomous choice to participate or not. The questionnaires were distributed personally by the principal investigator, who participated when the RNs tested and com- pleted the questionnaire. After that, the RNs and the principal investigator discussed the questionnaire. Minor modifications were made primarily to clarify the questions. Local community managers with supervisory responsibility for care of older people and the managers for each residential care homes gave their permission for the study. The target popu- lation was identified by the managers. The managers provided the information on the total number of employed RNs and their names. The principal investigator assured confidentiality. The postal questionnaires were distributed in sealed envelopes to the RNs at their work, either by their managers or by the principal investigator. The envelope to the RNs included a cover letter explaining the aim of the study; a statement to convey the study’s importance to participants; a statement assuring them of confidentiality; infor- mation that data would be kept protected; and a statement to encourage their replies (see Cohen et al. 2005). A postage-paid return envelope was also included. Three reminders were sent directly to the RNs when necessary. Data analysis The software used was Statistical Package for the Social Sciences (SPSS) for Windows version 17.0 (SPSS Inc., Chicago, IL, USA). The findings are shown in Table 1 and Supporting Information Table S1 in absolute frequency (number = n), relative frequency (%) and in running text. The relative frequency was rounded to integers (Altman 1997). Median was used to describe the average value and quartiles were used to describe the spread of data at a non-parametric level. Spearman’s analysis of rank correlation (rho) (Altman 1997) was used to measure the associations between time, competence and emotional pressure with RNs’ perceptions of their own health, sickness presence and sickness absence. Spearman’s analysis of rank correlation is a non- parametric measure of statistical dependence between two vari- ables (Altman 1997). The internal loss of data was minimal and data was neither replaced nor imputed. Ethical considerations This study was approved by the Ethics Committee of Karolinska Institutet, Stockholm (D. no: 317/02). The RNs related their perceptions of work-related health, sick- ness absence and sickness presence. This personal and sensitive information had to be respected by the investigator. The inves- tigator strove to prevent discomfort and violation of integrity. All potential participants were given an autonomous choice to par- ticipate or not. It was made clear that the investigators did not work at the request of any of the RNs’ employers. There was no dependence between investigators and partici- pants, which could influence the participants. Participants were informed that returned questionnaires were only to be seen by the investigators. Participants were thoroughly informed that their identities was protected, and that collected data was acquired with no connections between name and work unit. Information about the possibility of being informed of results was provided. Findings Supporting Information Table S1 provides a summary of the statistics for RNs’ ratings of work-related health problems during the past year. Registered nurses’ health in community elderly 411 © 2012 The Author. International Nursing Review © 2012 International Council of Nurses At the end of the working day, many RNs expressed difficulty leaving their thoughts about work behind (daily difficulties, 16%; difficulties some times a week, 23%; difficulties some times a month, 18%; difficulties once in a while, 38%; no difficulties, 10%). The majority of the RNs felt at times psychologically exhausted after work (often 12%; rather often 28%; sometimes 52%; never 8%). Most felt at times physically exhausted after work (often 15%; rather often 21%; sometimes 51%; never 13%). Thirty-seven per cent of the RNs had episodes of fatigue/ unhappiness/sadness because of their work and found difficul- ties overcoming these feelings. Of the RNs, n = 213 stated these episodes occurred several times a year (51%), sometimes (37%) and rarely (12%). These episodes lasted either always (8%), some months (4%), some weeks (31%) or some days (57%). RNs felt, on a scale of 1 (absolutely not) to 5 (yes, without hesitation), working in care for older people was psychologically (median 4, inter quartile range 3–5) and physically stressful (median 4, inter quartile range 3–5) in the long run. The findings indicated that 68% had worked during the past year despite feeling that sickness absence was necessary. Accord- ing to the RNs, this situation arose several times (57%), many times (9%) and once (34%) during the past year. Sixty-three per cent of the RNs stated sickness absence during the past year. RNs stated the number of times they had been on sickness absence during the past year (0 times, 37%; 1–3 times, 50%; 4–6 times, 9%; 7–10 times, 3%; >10 times, 1%). The majority of RNs perceived, on a scale of 1 (absolutely too low) to 5 (absolutely too high), high levels of time pressure at work (median 4, interquartile range 3–4). The majority of RNs perceived, on a scale of 1 (absolutely too low) to 5 (absolutely too high), adequate levels of competence pressure at work (median 3, interquartile range 3–3). The majority of RNs perceived, on a scale of 1 (absolutely too low) to 5 (absolutely too high), adequate levels of emotional pressure at work (median 4, inter- quartile range 3–4). Spearman’s P showed a significantly positive correlation between RNs’ perceived time pressure and 18 of all 19 variables in Table 1, measured RNs’ perceived work-related health prob- lems, sickness presence and sickness absence. The associations varied from weak to moderate. Moreover, Spearman’s P revealed a significantly positive although weak correlation between RNs’ perceived competence pressure and two of 19 variables (Table 1). Spearman’s P revealed a significantly positive correlation between RNs’ perceived emotional demands and 11 of 19 vari- ables (Table 1). The associations were weak. Table 1 Correlation coefficients between time, knowledge and emotional pressure perceived by registered nurses (RNs) and their ratings of work-related health problems during the past year Variables RNs (n = 213) Time pressure Competence pressure Emotional pressure Spearman’s rank correlation (rho) Acid indigestion, discomfort or stomach ache 0.261, P < 0.01 0.010 0.118 Gas, stomach ache, diarrhoea 0.229, P < 0.01 0.011 0.253, P < 0.01 Abdominal pain (unrelated to menstruation) 0.327, P < 0.01 0.000 0.226, P < 0.01 Common cold or respiratory tract infection 0.075 0.087 0.090 Dry skin or dry mucous membranes (eyes, nose, mouth, pharynx) 0.140, P < 0.05 0.006 0.099 Headache (unrelated to menstruation) 0.275, P < 0.01 0.035 0.091 Feeling faint 0.247, P < 0.01 0.058 0.233, P < 0.01 Nausea 0.212, P < 0.01 0.146, P < 0.01 0.163, P < 0.01 Neck or back disorders 0.255, P < 0.01 0.006 0.163, P < 0.05 Muscles or joints disorders 0.312, P < 0.01 0.122 0.226, P < 0.01 Sleep disorders 0.275, P < 0.01 0.123 0.187, P < 0.01 Worried and restless 0.333, P < 0.01 0.173, P < 0.05 0.240, P < 0.01 Difficulties leaving thoughts about work behind after the work day 0.369, P < 0.01 0.075 0.167, P < 0.05 Psychologically exhausted after the work day 0.426, P < 0.01 0.023 0.303, P < 0.01 Physically exhausted after the work day 0.142, P < 0.01 0.109 0.073 Episodes of fatigue/unhappiness/sadness, difficult to overcome 0.347, P < 0.01 0.067 0.188, P < 0.01 Sickness presence, that is, worked despite need for sickness absence 0.309, P < 0.01 0.002 0.126 Number of days with sickness absence 0.214, P < 0.01 0.007 0.101 Number of occasions with sickness absence 0.139, P < 0.01 0.022 0.021 412 K. Josefsson © 2012 The Author. International Nursing Review © 2012 International Council of Nurses Discussion The main findings indicated that RNs reported work-related health problems, sickness absence (63%), sickness presence (68%) and high time pressure at work. This was a distressing result since we are experiencing an unprecedented global nursing shortage (Buchan & Aiken 2008; ICHRN 2007; Oulton 2006). The nursing shortage is undermining the goals of health systems globally and challenging nursing’s ability to meet the needs of the citizens. Moreover, nursing shortages are linked to increased mortality, staff violence, accidents/injuries, cross infection and adverse postoperative events (Aiken et al. 2010; Lucero et al. 2010; Oulton 2006). The key reasons for the nursing shortage are unhealthy work environments and the poor organizational climate that characterize many workplaces (ICHRN 2007). Thus, to create healthy workplaces and also retain RNs in active prac- tice is the key to resolving the present nursing shortage in the industrialized world and in developing countries. This study showed that RNs perceived work-related health problems. Disheartening findings, since perceived ill health among nursing staff correlated with burnout (Ilhan et al. 2008). A current study (Fronteira & Ferrinho 2011) showed burnout and higher work dissatisfaction among RNs working in care for older people than among RNs working in other areas of practice. Lim et al. (2010) reported that stressors including shortage of staff and high work demands can lead to ill health. More, RNs experienced work dissatisfaction and had intentions to change profession as a result of work-related stress. Work-related health problems are most often caused by orga- nizational factors (Ilhan et al. 2008; Oulton 2006; Peterson 2009). Lack of adequate resources has also been found a major reason for health problems, such as burnout (Ilhan et al. 2008; Peterson 2009). Arnetz (2008) showed that 40% of work-related health problems were explained by organizational factors, whereas only 10% of work-related health could be explained by personality factors. Some aspects of personality can play a role in the process of burnout, especially the positive aspects of person- ality that can act as a protective factor (Garrosa et al. 2008). RNs in this study perceived work-related neck or back disor- ders, dry skin/dry mucous membranes, muscles/joints disorders, sleep disorders and headache. Muscles/joints disorders have been confirmed by a current systematic review of experimental and observational studies on RNs’ physical health (Fronteira & Fer- rinho 2011). RNs suffered more from musculoskeletal disorders than other care workers. RNs’ perceived work-related problems should be considered from the viewpoint that RNs are the only professional group with education and certification in advanced nursing. Thus, RNs are key figures for taking care of seriously ill people, such as older people with severe dementia and multiple diagnoses, and dying people in community care (Josefsson 2006). The most important recommendation for practice is to create healthy workplaces. The International Council of Nurses described, through ICHRN (2007), positive practice environments as workplaces that strive to ensure the health, safety and personal well-being of staff, support quality patient care and improve the motivation, pro- ductivity and performance of individuals and organizations. Improved leadership and organization would not only evidently decrease sick rates but also improve productivity (Arnetz 2008). Employers should support RNs, with continuous supervision focusing on demands and their effect on RNs’ health in commu- nity care of older people. Moreover, improving RNs’ working conditions may improve both RNs’ and patients’ satisfaction as well as the quality of care (McHugh et al. 2011). This study revealed that health problems are not necessarily followed by sickness absence, confirmed by Aronsson & Gustafs- son (2005). Staff may turn up for work despite believing they are too sick to work. Findings of this study showed that 68% of the RNs reported attending their workplaces during the past year, despite feeling so sick that they should have stayed at home. According to over half of the RNs in this study, the situation of sickness presence arose several times during the past year. An explanation might be that professional norms and moral obliga- tions place pressure on RNs to work even though ill (Crout et al. 2005). RNs might also lower their thresholds for sickness absence when caregivers are understaffed (Elstad & Vabö 2008; Lim et al. 2010). This study was in agreement with Aronsson et al. (2000), who reported that staff providing care or welfare services have an increased risk for sickness presence. Furthermore, the findings emphasized that rate of sickness do not always reveal all aspects of RNs’ perceived health or health problems. Therefore, politi- cians, employers and nurse managers should take the RNs’ high sickness presence and sickness absence seriously. The main chal- lenge for policy makers is to develop a coordinated package of policies that provide a long-term and sustainable solution with healthy workplaces (Buchan & Aiken 2008; ICHRN 2007). Further studies on the health of the nursing staff should concen- trate not only on sickness absence but on sickness presence as well (Elstad & Vabö 2008). Many RNs had difficulties leaving their thoughts behind after the working day. In addition, the majority of the RNs sometimes felt psychologically and physically exhausted after work. Findings indicated that 37% of RNs had work-related periods of fatigue/ unhappiness/sadness from which it was difficult to recover. These episodes occurred, on average, several times yearly. These findings have been confirmed by previous studies reporting that RNs work under physical and emotional pressure in community care of older people (Hallin & Danielson 2007b; Josefsson et al. Registered nurses’ health in community elderly 413 © 2012 The Author. International Nursing Review © 2012 International Council of Nurses 2007). It is important to keep work and life in balance. Thus, employers need to adopt innovative programmes and opportu- nities that encourage employees to better balance their work days with their home and family life. The findings in this study were also in line with previous reports that nursing is a risk profession with high levels of stress (Aronsson et al. 2000; Clegg 2001; Fronteira & Ferrinho 2011; Garrosa et al. 2008; Lim et al. 2010). Garrosa et al. (2008) also predicted that stress levels in nursing are most likely increasing. Their assumption was supported by the RNs’ perceptions in this study, that is to say they felt that working with care of older people was psychologically and physically stressful in the long run. Moreover, findings in this study were in line with a recent report that RNs, regardless of gender, are among the most vul- nerable occupational groups when it comes to sickness absence because of mental health problems (AFA Insurances 2006). This study showed that the majority of RNs perceived high time pressure at work in the community care of older people. The result is in accordance with earlier studies (Hallin & Daniel- son 2007a; Josefsson et al. 2007). A substantial proportion of RNs stated they were not able to complete their work tasks during working hours (Josefsson et al. 2007). One major reason for the time pressure, stated by RNs in care of older people, was the increasing number of care recipients without a correspond- ing increase in resources (Swedish Institute of Family Medicine 2003). RNs considered high time pressure as a greater obstacle than difficult work tasks (Hallin & Danielson 2007a). Time pres- sure was also the foremost factor for RNs’ work dissatisfaction (Hasson & Arnetz 2008). There is presently a shortage of RNs in community care of older people and a considerable increase is expected in the number of RNs’ retirements (Josefsson 2006; Oulton 2006). In light of this and findings in this study, it is especially important to take RNs’ work-related health problems and the consequences of RNs’ time pressure at work seriously. Because of the fact that RNs’ perceived time pressure were significantly correlated with nearly all (18 of 19) variables measuring RNs’ work-related health problems. In spite of the fact that the correlations varied from weak to moderate, this should be taken seriously. For the sake of safe care, we cannot afford a greater shortage of RNs in the community care of older people. Methodological considerations This study is limited by the lack of description regarding staffing, such as whether there were numerous unfilled vacancies. Never- theless, these findings have an important value and are relevant to clinical practice. Although this applies to most questionnaires, the use of the questionnaire in which the participants only answered in those domains determined by the researcher might be a weakness (Polit & Beck 2008). On the other hand, partici- pants were given an opportunity to comment at the end of the questionnaire. The internal loss of data was neither replaced nor imputed, as the overall percentage of missing data was low. Power calculation was not used since this study is explorative and descriptive. Consequently, generalizations beyond this study should be made with caution. However, the results may reflect the perceptions of RNs working in similar conditions. Conclusion In conclusion, this study highlighted RNs’ work-related health problems, high sickness presence and high sickness absence in the community care of older people, as well as perceived time pressure at work. This study showed that further studies on the health of the nursing staff should include sickness presence. This study underlines the importance of taking action to prevent RNs’ work-related health problems and time pressure at work. It requiresconcertedaction–acombination of strategies globally, nationally, regionally and locally. Acknowledgement I am grateful to the RNs who so willingly agreed to participate in this study. This research was supported by Mälardalen Univer- sity, Sweden and a fellowship from Dementia Association – The National Association for the Rights of the Demented, Sweden. References AFA Insurances (2006) Allvarliga arbetsskador och långvarig sjukfrånvaro [Serious work injuries and prolonged sick leave]. AFA Insurances (in Swedish), Stockholm. Aiken, L.H., et al. (2010) Implications of the California nurse staffing mandate for other states. Health Services Research, 45, 904–921. Altman, D.G. (1997) Practical Statistics for Medical Research. Chapman & Hall, London. Arnetz, B. (2008) Frisk stress och välbefinnande i kunskapssamhället [Healthy Stress and Well Being in the Society of Knowledge]. Uppsala Uni- versity, Uppsala. Aronsson, G. & Gustafsson, K. (2005) Sickness presenteeism: prevalence, attendance-pressure factors, and an outline of a model for research. Journal of Occupational and Environmental Medicine, 47, 958–966. Aronsson, G., Lantz, A. & Westlander, G. (1992) Akademiker under1990- talet. En studie av SACO-medlemmarnas arbetsvillkor. Undersökningsin- strument och studiens bakgrund [Academics during 1990s. A Study of Members Works Conditions of The Swedish Confederation of Professional Associations. The Instrument of Investigation and Background of the Study]. Arbetsmiljöinstitutet, Solna. Aronsson, G., Gustafsson, K. & Dallner, M. (2000) Sick but yet at work. An empirical study of sickness presence. Journal of Epidemiology and Com- munity Health, 54, 502–509. Buchan, J. & Aiken, L.H. (2008) Solving nursing shortages: a common pri- ority. Journal of Clinical Nursing, 17, 3262–3268. 414 K. Josefsson © 2012 The Author. International Nursing Review © 2012 International Council of Nurses Clegg, A. (2001) Occupational stress in nursing: a review of the literature. Journal of Nursing Management, 9, 101–106. Cohen, L., Manion, L. & Morrison, K. (2005) Research Methods in Educa- tion. RoutledgeFalmer, London. Crout, L.A., Chang, E. & Cioffi, J. (2005) Why do registered nurses work when ill? The Journal of Nursing Administration, 35, 23–28. Eley, R., et al. (2007) Aged care nursing in Queensland – the nurses’ view. Journal of Clinical Nursing, 16, 860–872. Elstad, J.I. & Vabö, M. (2008) Job stress, sickness absence and sickness pre- senteeism in Nordic elderly care. Scandinavian Journal of Public Health, 36, 467–474. Fronteira, I. & Ferrinho, P. (2011) Do nurses have a different physical health profile? A systematic review of experimental and observational studies on nurses’ physical health. Journal of Clinical Nursing, 20 (17/ 18), 2404–2424. Garrosa, E., Moreno-Jime’nez, B., Liang, Y. & González, J.L. (2008) The relationship between socio-demographic variables, job stressors, burnout, and hardy personality in nurses: an exploratory study. Interna- tional Journal of Nursing Studies, 45, 418–427. Hallin, K. & Danielson, E. (2007a) Registered nurses’ perceptions of their work and professional development. Journal of Advanced Nursing, 61, 62–70. Hallin, K. & Danielson, E. (2007b) Registered nurses’ experiences of daily work, a balance between strain and stimulation: a qualitative study. International Journal of Nursing Studies, 44, 1221–1230. Hasson, H. & Arnetz, A. (2008) Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes. Journal of Clinical Nursing, 17, 468–481. ICHRN (International Centre for Human Resources in Nursing) (2007) An Ageing Nursing Workforce. Available at: http://www.ichrn.com/ publications/factsheets/Ageing_Workforce-English.pdf (accessed 2 February 2012). Ilhan, M., et al. (2008) Burnout and its correlates among nursing staff: questionnaire survey. Journal of Advanced Nursing, 61, 100–106. Josefsson, K. (2006) Municipal Elderly Care: Implications of Registered Nurses’ Work Situation, Education, and Competence. Doctoral Disserta- tion. Karolinska Institutet, Stockholm. Josefsson, K., Sonde, L., Winblad, B. & Robins Wahlin, T B. (2007) Work situation of registered nurses in municipal elderly care in Sweden: a questionnaire survey. International Journal of Nursing Studies, 44, 71–82. Josefsson, K., Sonde, L. & Robins Wahlin, T B. (2008) Competence devel- opment of registered nurses in municipal elderly care in Sweden: a ques- tionnaire survey. International Journal of Nursing Studies, 45, 428–441. Karasek, R. & Theorell, T. (1990) Healthy Work: Stress, Productivity, and the Reconstruction of Working Life. Basic Books, New York, NY. Karlsson, I., Ekman, S L. & Fagerberg, I. (2009) A difficult mission to work as a nurse in a residential care home – some registered nurses’ experiences of their work situation. Scandinavian Journal of Caring Sci- ences, 23, 265–273. Lim, J., Bogossian, F. & Ahern, K. (2010) Stress and coping in Singaporean nurses: a literature review. Nursing & Health Sciences , 12, 251–258. Lucero, R.J., Lake, E.T. & Aiken, L.H. (2010) Nursing care quality and adverse events in US hospitals. Journal of Clinical Nursing, 19, 2185– 2195. McHugh, M.D., et al. (2011) Nurses’ widespread job dissatisfaction, burnout and frustration with health benefits signal problems for patient care. Health Affairs (Project Hope), 30, 202–210. Oulton, J.A. (2006) The global nursing shortage: an overview of issues and actions. Policy, Politics & Nursing Practice, 3, 34–39. Peterson, U. (2009) Stress and Burnout in Health Care Workers. Doctoral Dissertation. Karolinska Institutet, Stockholm. Polit, D.F. & Beck, C.T. (2008) Nursing Research. Generating and Assessing Evidence for Nursing Practice. Lippincott, New York. SALAR (The Swedish Association of Local Authorities and Regions) (2005) Swedish Health Care in an International Context – A Comparison of Care Needs, Costs, and Outcomes. Available at: http://www.skl.se (accessed 2 February 2012). Stordeur, S., D’Hoore, W. & Vandenberghe, C. (2001) Leadership, organi- zational stress, and emotional exhaustion among hospital nursing staff. Journal of Advanced Nursing, 35, 533–542. Swedish Institute of Family Medicine (2003) Problem Detection Study – sjuksköterskor och enhetschefer inom kommunal äldrevård och hems- jukvård. [Problem Detection Study – Registered Nurses and Managers in Community Elderly Care and Home Care]. Swedish Institute of Family Medicine, Stockholm. Tummers, G.E.R., Landeweerd, J.A. & Van Merode, G.G. (2002) Work organization, work characteristics, and their psychological effects on nurses in the Netherlands. International Journal of Stress Management, 9, 183–206. United Nations (2009) World Population Ageing 2009. Available at: http:// www.un.org/esa/population/publications/WPA2009/WPA2009_ WorkingPaper.pdf (accessed 2 February 2012). Supporting information Additional Supporting Information may be found in the online version of this article: Table S1 Registered nurses’ (RNs’) ratings of work-related health problems during the past year Please note: Wiley-Blackwell are not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article. Registered nurses’ health in community elderly 415 © 2012 The Author. International Nursing Review © 2012 International Council of Nurses . (2012) Registered nurses’ health in community elderly care in Sweden. International Nursing Review 59, 409–415 Aim: To describe registered nurses’ (RNs) ratings. ratings of work-related health problems during the past year. Registered nurses’ health in community elderly 411 © 2012 The Author. International Nursing