Psychological Demans and Decision Latitude Within Health Care Work : Relation to Health and Significance

Sammanfattning: The general aim of this thesis is to provide a scientific evaluation of the psychosocial work environment for health care personnel. The theoretical basis is the demand-control model developed by Karasek and Theorell. The model consists of the dimensions psychological demands and decision latitude, the latter is a combination of intellectual discretion and authority over decision.The results in study I indicated that there are strong relationships between job strain, high psychological demands and low decision latitude, and blood pressure during work among health care personnel. In study II, symptoms from the low back were associated with all three dimensions psychological demands, skill discretion and decision authority while symptoms from the neck were related to lack of work support. The results in study III indicated that the combination of somatic and psychiatric care could be associated with higher levels of job strain and psychological symptoms.Study IV showed that substantial changes in working conditions had been frequent in the public sector during the period 1988-1996 and that registered nurses and nurse assistants had very different developments. Registered nurses had got a more intense work environment with increased skill utilization but also increased hindrances to perform work. Nurse assistants on the other hand had experienced decreased skill utilization. Temporary employment and part time work, common among health care personnel with low education, were the factors that explained the greatest part of deterioration of skill utilization and possibility to take part in planning of work. These different trends may negatively influence social climate as these two occupational groups often work together.Study V is a qualitative validation of the demand-control model. The findings showed that the model is equally relevant for women as for men and also relevant for health care personnel. Compared to occupational groups working with either "things" or "symbols" health care personnel experienced higher levels of psychological demands and lower levels of decision latitude.It is concluded that the demand-control scale is relevant for use in studies of psychosocial work environment in health care, possibly supplemented with the effort-reward scale. In order to reach a more solid understanding of the psychosocial work environment, questionnaire data should be combined with qualitatively analyzed interviews. The indications of a deteriorated psychosocial work environment for health care personnel in this and other studies calls for radical changes that promote less psychological demands and more decision latitude within this occupational sector.