Psychosocial working conditions among general practitioners and district nurses : Organisational, professional and gender aspects

Sammanfattning: This thesis focuses on the psychosocial working conditions shared by general practitioners and district nurses in Sweden, in relation to the personal doctor reform and district nurses' right to prescribe drugs.First, a questionnaire was compiled and developed through a stepwise development phase, including key informant interviews, literature review, and review of other models and questionnaires used with a similar purpose. The questionnaire developed was used in a pilot study with 42 general practitioners and 39 district nurses. The questionnaire with 78 items in different parts, was tested for construct validity through factor analysis, and for reliability through Cronbach's alpha. It was then used in the main study.One aim was also to compare perceived changes in working conditions between general practitioners and district nurses during different degrees of implementation of a personal doctor system. A sample of 469 general practitioners and 466 district nurses participated. The cross-sectional design makes it difficult to distinguish the possible direct effects of a personal doctor from other regional differences. However, is it important to note that the personnel in a more far-reaching personal doctor system perceived less favourable psychosocial working conditions than personnel in a more traditional primary care system.Another aim was to investigate gender and professional differences in the shared psychosocial working conditions. Both general practitioners and district nurses were satisfied with the professional content of their work and experienced rather low or moderate levels of strains -and symptoms. However, female general practitioners perceived the most unfavourable working conditions compared with both male colleagues and female district nurses.The opinions among general practitioners and district nurses, to district nurses' right to prescribe drugs differed in all aspects studied. District nurses were positive and general practitioners negative. To gain a deeper understanding of the different opinions, six focus group interviews was carried out. The resistance to the refonn had turned into silence. General practitioners and district nurses hardly speak to each other about prescribing. The district nurses were uncertain whether the general practitioners trusted them and made up systems for self-control.The personnel within a more far-reaching personal doctor system perceived less-favourable psychosocial working conditions compared with personnel in more traditional primary care system. Female general practitioners seem to experience the most unfavourable working conditions. compared with both their male counterparts, and female district nurses. District nurses prescribing highlights professional differences. Quantitative and qualitative data complement each other and give more diverse information.