TAKING CARE OF OTHERS - WHAT'S IN IT FOR US? Exploring workplace-related health from a salutogenic perspective in a nursing context

Abstract: The aim was to explore and make sense of a salutogenic relationship between workplace, work and health, through an employee perspective in a Swedish nursing context. The aim was also to make sense of the role of a workplace health promotion (WHP) process, in a salutogenic public health perspective, and develop useful instruments for this kind of health-related development work. The research process, which was predominantly carried out within the framework of a WHP process at a hospital ward, was characterized by a salutogenic perspective and an action and mixed method approach.

Four studies were carried out at a medium-sized hospital in the south of Sweden and the studies of papers I, II and III were conducted within the framework of a WHP process at the study ward. The development process started with a focus group study, to explore workplace-related resources and health, through the eyes of healthcare workers. The second study explored factors associated with the experience of flow during everyday nursing practice, through an experience sampling method. The third study within the framework of the project, was a focus group study attempted at making sense of the participating health care workers thoughts about the WHP process. The fourth study was a quantitative cross-sectional study aiming for a development and quality assessment of a salutogenic health indicator scale (SHIS).

The research process resulted in a predominant focus on social and psychological resources for and indicators of health. The identified workplace-related health resources interacted through a complex mutual influential relationship and they could be related to the reward, the team, the mission and the context. The resources of rewarding positive experiences and emotions were considered the core of a health promoting workplace. The findings indicated that there were possibilities for more positive workplace- and work-related experiences through focus on cognitive resources and medical care activities with adherent experiences of flow among the healthcare workers in general and among the assistant nurses in particular.

The participants were considered more or less achievement-oriented based on their preferring two rather different characteristics of work and WHP processes. More achievement-orientation was related to flexibility, reflection, learning and development of everyday practice. Less achievement-orientation was instead linked to stability, piece and quiet and WHP process-related social relations in general. These diversities were related to complexity and were considered useful for WHP practice. The diversities need to be identified and discussed in a WHP context that is characterized by individual resources, group interaction and external support. A WHP process also needs valid, reliable and practicable instrumental support. The SHIS is considered useful for measuring health with a salutogenic and holistic perspective in general and is thus useful for WHP with a salutogenic approach in particular. It is, however, important that the instrument is used together with a salutogenic perspective and in a context based on social processes, interaction, reflection, learning.

The findings adds knowledge to complex relations between workplace as a context, work as an activity, WHP with a salutogenic and bottom-up approach as a change process and health of healthcare workers as a goal. The findings can also directly be applied in practice, as support for an implementation of workplace-related health promoting structures and processes.