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Biomedical subjects

B Arnetz

Publications and source records attributed to B Arnetz.

At least 19 recordsLinked to original sources
PubMed2001

A comparative study of the experiences of violence of English and Swedish mental health nurses.

Recent studies suggest that violence in health care environments, especially mental health care, appears to be increasing. Although there is a lack of cross-cultural studies to prove it, this increase in violence would seem to be an international phenomenon. The present study sought to compare the extent and nature of violence encountered by mental health nurses in Sweden and England. Systematic studies of violence have previously been carried out independently in both countries but this was the first attempt to compare levels of violence. Clearly defined study protocols were put in place, an operational definition of 'violence' adhered to, and random samples recruited. A specially designed questionnaire was sent to every subject (Swedish nurses n=720; English nurses n=296) enquiring about the extent of nurses' exposure to violence, the nature and severity of the violence experienced, and the effect of violence on self-esteem and job satisfaction. Significant differences were found with English nurses experiencing more violence than their Swedish counterparts. Yet support for English nurses appeared to be less good than for Swedish nurses. Reasons for the differences are discussed along with possible measures to minimise the frequency of violence against nurses and the negative effects on their work.

Adult↗
PubMed2001

Financial incentives in health care. The impact of performance-based reimbursement.

The key question addressed in this study is whether performance-based reimbursement (PBR) is a useful way to create the right incentive for efficiency improvements in health care. In this 4-year prospective cohort study, physicians in one council with PBR and in ten councils without such a system were studied. The results of this study indicate that PBR, compared to an annual budget system, creates a different incentive, an 'inner incentive' which may be stronger than the external incentive of financial pressures. PBR may result in a greater cost awareness and shorter average length of stay, but it may also lead to negative effects on the quality of care. A strong cost awareness was found to be a negative predictor of quality of care indicating that it is a difficult balancing act to maintain cost considerations at a 'good' level in order to retain the benefits of cost awareness without adversely impacting quality of care. There is a need for further studies of the impact of PBR on financial performance and quality of care issues.

Adult↗
PubMed2000

Provocation with stress and electricity of patients with "sensitivity to electricity".

Twenty-four patients with self-reported "sensitivity to electricity" were divided into two groups and tested in a double-blind provocation study. These patients, who reported increased skin symptoms when exposed to electromagnetic fields, were compared with 12 age- and sex-matched controls. Both groups were exposed to 30-minute periods of high or low stress situations, with and without simultaneous exposure to electromagnetic fields from a visual display unit. The matched controls were tested twice and given the same exposure as the patients but had the fields turned on every time. Stress was induced by requiring the participants to act in accordance with a random sequence of flashing lights while simultaneously solving complicated mathematical problems. Blood samples were analyzed for levels of the stress-related hormones melatonin, prolactin, adrenocorticotrophic hormone, neuropeptide Y, and growth hormone, and the expression of different peptides, cellular markers, and cytokines (somatostatin, CD1, factor XIIIa, and tumor necrosis factor-alpha). Skin biopsies were also analyzed for the occurrence of mast cells. Stress provocation resulted in feelings of more intense mental stress and elevated heart rate. The patients reported increased skin symptoms when they knew or believed that the electromagnetic field was turned on. With the blind conditions there were no differences between "on" or "off." Inflammatory mediators and mast cells in the skin were not affected by the stress exposure or by exposure to electromagnetic fields. The main conclusion was that the patients did not react to the fields.

Antibodies↗
PubMed2000

Effects of performance-based reimbursement in healthcare.

The aim of this study was to assess changes in attitudes and behaviour related to efficiency and quality of care after introduction of performance-based reimbursement. The study consisted of two parts. Part One was performed in 1992-94 as a repeated cross-sectional study of physicians in Stockholm County Council working with a newly introduced performance-based reimbursement system. Part Two was a similar study conducted in 1994 in 11 Swedish councils without performance-based reimbursement. The results show a significant difference between the two groups of physicians in attitudes concerning changes in quality of care and premature discharge from hospital. Despite concern about quality and premature discharge, physicians in Stockholm were found to have changed their behaviour in that the average length of stay in 1994 was about one day shorter in Stockholm than in the other 11 county councils. This indicates that the performance-based reimbursement system may strengthen the incentive to increase efficiency.

Attitude of Health Personnel↗
PubMed1999

A comparative study of the perceptions of British mental health nurses and psychiatrists of their work environment.

This comparative study of the perceptions of mental health nurses and psychiatrists about aspects of their work environment was undertaken in the West Midlands in England. The aim of the study was to ascertain the extent to which the environment in which mental health professionals' work impacts on their own mental and physical well-being. Seventy-four psychiatrists and 301 mental health nurses responded to a postal questionnaire. Analysis of data indicated that significant differences exist between nurses and psychiatrists in their working conditions, their physical working environment, their sources of support with a work-related problem, and the effects of their work on their own mental and physical health. The main recommendation derived from this study was to improve communication between mental health professionals and their managers by giving more structured feedback and guidance about one's work performance. This may help to alleviate the mental strain many mental health professionals experience in their work.

Adaptation, Psychological↗
PubMed1999

Individual and organizational well-being in psychiatric nursing: a cross-cultural study.

Although health care systems around the world are undergoing rapid changes, there is an absence of comparative studies of how these changes affect nurses' well-being and work life. The purpose of this study was (i) to identify and describe possible differences between the psycho-social work environments of English and Swedish mental health nurses, and (ii) to attempt to explain these differences. 1016 psychiatric nurses from Stockholm (Sweden) and Birmingham (England) responded to a postal questionnaire on their psycho-social work environment and feelings of professional fulfillment, mental energy and work-related exhaustion. The study was given ethical clearance in Stockholm and Birmingham. Results indicated that while the English nurses rated their organizational well-being more favourably, Swedish psychiatric nurses reported greater individual well-being than their counterparts. Multiple regression analyses indicated that self-esteem was important for explaining mental energy and work-related exhaustion, but less so for explaining professional fulfillment, which was predicted primarily by organizational factors. When controlling for self-esteem, which was higher amongst the Swedish nurses, the differences in professional fulfillment and mental health were no longer significant. Reasons for the differences in self-esteem and experiences of the workplace are discussed. Low response rate may have contributed to a selection bias.

Adult↗
PubMed1999

Violence in mental health care: the experiences of mental health nurses and psychiatrists.

Violence against mental health service personnel is a serious workplace problem and one that appears to be increasing. This study aimed to ascertain the extent and nature of violence against mental health nurses and psychiatrists, and to identify what support, if any, they received following exposure to violence. Mental health staff working within five West Midlands Trusts in the United Kingdom were surveyed using a postal questionnaire to investigate the extent and nature of violence they encountered in their daily work. There was an overall response rate of 47%, which included a response rate for psychiatrists of 60% (n=74) and for mental health nurses of 45% (n=301). Though both groups experienced violence at work, nurses were found: to have been exposed to violence significantly more during their career; to have been a victim of violence within the previous 12 months of the survey; and to have suffered a violent incident involving physical contact. Whilst a higher proportion of nurses than psychiatrists received some support following a violent incident, a large proportion of both groups did not receive any, although most felt in need of it. The implications of this study for training and management are discussed.

Adult↗
PubMed1999

A 50-Hz electromagnetic field impairs sleep.

In view of reports of health problems induced by low frequency (50-60 Hz) electromagnetic fields (EMF), we carried out a study in 18 healthy subjects, comparing sleep with and without exposure to a 50 Hz/1 mu Tesla electrical field. We found that the EMF condition was associated with reduced: total sleep time (TST), sleep efficiency, stages 3 + 4 slow wave sleep (SWS), and slow wave activity (SWA). Circulating melatonin, growth hormone, prolactin, testosterone or cortisol were not affected. The results suggest that commonly occurring low frequency electromagnetic fields may interfere with sleep.

Adolescent↗
PubMed1999

Feelings of professional fulfilment and exhaustion in mental health personnel: the importance of organisational and individual factors.

BACKGROUND: Mental health personnel are at high risk for mental illness, burnout and suicide. Previous studies of this group of professionals have indicated the importance of organisational factors in explaining burnout, or exhaustion, and work satisfaction. This study looks more systematically at the contribution of organisational and individual factors to work-related exhaustion and to professional fulfillment, an expanded version of job satisfaction. METHODS: A cross-sectional study of 1, 051 psychiatrists and mental health nurses in the city of Stockholm was carried out by postal questionnaire with a previously validated instrument. Multiple and logistic regressions were used to identify predictors of exhaustion and professional fulfillment. RESULTS: Organisational characteristics were found to be more important than individual characteristics in predicting exhaustion and professional fulfillment in mental health professionals. CONCLUSIONS: The results indicate that the psychosocial work environment and well-being of mental health professionals can be improved by concentrating on organisational factors such as efficiency, personal development and goal quality.

Adult↗
PubMed1998

Characteristics of users and nonusers of alternative medicine in dermatologic patients attending a university hospital clinic: a short report.

OBJECTIVES: To study the characteristics of users of alternative medicine in dermatologic outpatients attending a university clinic. DESIGN: A cross-sectional study analyzed by using a case-control methodology. SETTING, SUBJECTS, AND STUDY MEASURES: 118 dermatologic patients attending an outpatient university clinic responded to a structured questionnaire concerning demographic data, medical history, experience with alternative medicine, health beliefs, lifestyle, and locus of control. RESULTS: Thirty-five percent of the patients reported having used some form of alternative medicine. Use was related to disease duration, but not to patients' beliefs regarding whether or not they could influence their own health, nor to dissatisfaction with orthodox medicine. The most common reason for trying alternative medicine was that they "wanted to try everything" in an attempt to cure the skin disease. Users stated to a greater extent than nonusers, that they exercised sufficiently, possibly indicating that they are more health conscious. CONCLUSIONS: The study suggests that dermatologic patients using alternative medicine in general do not differ with regard to personal characteristics from nonusers. Rather, it appears that patients with long-standing skin disease turn to alternative medicine as a complement to orthodox treatment.

Case-Control Studies↗
PubMed1998

Predictors of a healthy workplace for Swedish and English psychiatrists.

BACKGROUND: Few studies have attempted to analyse the organisational aspects of the workplace that may affect the well-being of psychiatrists and even fewer have offered insights into what a positive workplace might look like. This study provides an outline of such a workplace, with reference to individual and organisational factors. In addition, a comparison is made between two European cities to check for cultural differences. METHOD: Three hundred and eighty psychiatrists from Stockholm and Birmingham responded to a previously tested questionnaire on their work environment. RESULTS: Predictors of a positive workplace for psychiatrists were: high self-esteem, satisfactory support with work-related problems, lower perceived workload, positive view of leadership, low work-related exhaustion and having a sense of participation in the organisation. There were few cultural differences. CONCLUSIONS: Measures should be taken to improve leadership skills for managers, to offer more support for work-related problems, and to allow psychiatrists to participate more in the organisation.

Anxiety↗
PubMed1997

Suicidal feelings and work environment in psychiatric nursing personnel.

Suicidal feelings, attempted suicide and aspects of work environment and well-being in Swedish psychiatric nursing personnel were studied using a questionnaire. The questionnaire, containing 190 questions, was mailed to all 242 nurses and attendants working in psychiatric care at the department of psychiatry at Karolinska Hospital. Eighty-one percent (n = 197) returned the questionnaire. Suicidal feelings "last year" were lower than in the general population, but suicidal feeling and attempted suicide "earlier than last year" were much more common, and 13% reported that they had attempted suicide earlier in life. In order to study the possible association between work environment and suicide, a factor analysis was performed. Four factors were extracted and labelled: suicidality, quality of work, negative work environment and burn out/depression. The correlation between the factors suggests that negative work environment is associated with burn out/depression, which in turn is related to suicidality. No direct link was demonstrated between suicidality and work environment, and completed suicide was not investigated. The study provides some indirect evidence that a negative work environment may increase suicidal feelings.

Adult↗
PubMed1997

Psychophysiological concomitants of organizational change in health care personnel: effects of a controlled intervention study.

BACKGROUND: To assess possible psychophysiological changes in personnel being exposed to organizational change and to assess the effects of a structured empowerment programme. METHODS: A randomized, prospective, controlled, and non-blinded intervention was carried out in two wards within a geriatric hospital. The I-ward (intervention) was offered a structured intervention programme with a trained, registered psychologist during 20 weekly 1-hour sessions before and after the organizational change. The C-ward (control) was passively attended by the same psychologist during equal time conditions. Blood pressure as well as pulse rate were taken and blood samples were drawn from all participants before (0 weeks), immediately after the intervention (20 weeks) and after another 10 weeks' follow-up (30 weeks). RESULTS: There was a significant time x group interaction with increasing prolactin levels on the C-ward as compared to decreasing levels on the I-ward during the intervention. CONCLUSIONS: Our study results suggest a picture of differentiated changes in stress hormone levels. The I-ward exhibited less psychoendocrine stress compared to the C-ward, probably due to the intervention and the possibility for personnel to influence the programme. We suggest that psychosocial empowerment programmes are beneficial when organizational changes are enacted in health care settings.

Adult↗
PubMed1997

Perceived relevance of psychosocial work site interventions for improved quality of health care work environment.

Changes due to reorganization of Swedish health care would have greater impact if the measures taken were strongly supported by the occupational groups involved. In a representative study of Swedish nurses, 90% considered psychosocial issues of great importance to their work environment. No differences were found between male and female nurses. 78% of the physicians in a large hospital study stated that their psychosocial work environment could be improved. Responses to an open-ended question to nurses and physicians showed differences in prioritized suggestions for an improved psychosocial work environment. Work climate, work load, competence development and organization appeared as the most important areas of changes to both nurses and physicians. Almost 40% of the total responses from the nurses compared to 20% from the physicians had to do with work climate interventions. Increased feedback and information, better means of communication and group relations were mentioned. Work load had higher priority according to the physicians. Other potential interventions were organizational issues like management, clarity of goals as well as competence development. In particular, there was a need for supervision and new competence in coping with critical incidents.

Adult↗
PubMed1997

[Restructuring the working schedule for Swedish physicians. Method for improving individual wellbeing and organizational conditions].

A growing number of studies have been focused on the health and well-being of physicians, and on such professional factors as self-perceived stress, influence over working procedures, professional skills and skills development, and scope for professional advancement. The rapid transition in the structure of health care has underlined the importance of involving physicians in the restructuring process. It is also imperative that of their own accord physicians involve themselves in issues concerning the work environment and organisational enhancement. The article outlines means by which physicians' work conditions may be assessed and the process of change facilitated. An instrument for internal and external auditing of skills, working conditions and quality is also briefly discussed.

Efficiency↗
PubMed1994

Impact on health care consumption of an experimental daycare intervention.

The purpose of the present study was to assess the impact on health care utilization of a controlled intervention programme for geriatric daycare patients. Sixty-five patients referred to daycare were allocated to an intervention and control group respectively. The 12-week programme was added to the ordinary daycare agenda and was designed in active collaboration with the patients in order to counteract passivity and enhance active patient involvement. Evaluations were made before and after 6 and 12 weeks of intervention, as well as 3 and 9 months after the conclusion of the programme. No extra resources were allocated to either the intervention or the control group. During the intervention period there were no changes in the utilization of home care for either group during the whole study period. Noticeably, there was a significant difference in the number of patients readmitted to hospital between the intervention and control groups (13/33 and 21/32 respectively). There was also a significant difference in favour of the intervention group concerning mean length of hospital stay (22.1 and 61.9 days respectively). The mean corresponding saving for each 12-week intervention patient during a one-year follow-up was calculated at 57,500 SEK. Even if our calculations are tentative and do not cover all aspects of the total cost, they indicate the importance of further studies of elderly patients discharged from daycare units and institutional settings.

Activities of Daily Living↗