Can an organizationally anchored, multilevel intervention improve perceived stress and psychosocial factors in the workplace? A pre-post study assessing effectiveness and implementation

BackgroundOrganizational multilevel interventions have been called for as a means to improve psychosocial working conditions, reduce stress, and enhance wellbeing in organizations. However, these types of interventions are highly complex to implement and evaluate, and they remain scarce in the literature. In this study, we present the evaluation of a multilevel intervention conducted in a municipality setting.MethodsThe intervention was based on a train-the-trainer principle and participatory risk assessment workshops on all organizational levels. Action plans were subsequently developed at the team level, and identified risks, which could not be addressed at the team level, were reported to the management for further action planning or escalation to the next management level. Using a pre-post study design, we evaluated changes in proximal outcomes related to the psychosocial working environment, and distal outcomes related to stress and job satisfaction. Changes over time in outcome measures were analyzed using linear mixed models. A quantitative process evaluation was used to examine the degree of implementation of the intervention.ResultsSmall improvements over time were observed with regard to quantitative demands, overall perception of the psychosocial work environment, job satisfaction, and the psychosocial safety climate. We also observed an increase in empowering leadership. Positive tendencies were also found for predicatability at work, possibilities for solving work tasks and support from closest manager. The effect sizes were small in all cases. No improvements in perceived stress or stress symptoms were found. The study revealed several practical and methodological challenges in conducting and implementing this type of multilevel intervention in a municipal setting.ConclusionsOverall, our study suggests that the intervention was associated with small positive changes in certain aspects of the working environment but no improvements were observed in stress outcomes. The study highlights a number of challenges in relation to implementing this type of multilevel intervention in a municipal setting.Trial RegistrationThe study was prospectively registered at ISRCTN84940247 on April 23, 2019

Contextualizing Violence Prevention – How Contextual Aspects Influence the Implementation of a Violence Prevention Initiative in Prisons and Psychiatry

The aim of this study was to investigate which contextual aspects and mechanisms are decisive in the implementation of an integrated, tailored intervention to prevent violence and threats of violence from patients or inmates towards employees in psychiatric units and in prisons and detention centers. Based on a standardized implementation degree assessment of fidelity, reach and dose delivered, we selected two workplace cases from each sector, one with a high and one with a low implementation degree. Using a realist evaluation framework, we conducted a thematic analysis of the four selected workplace cases to identify prevalent contextual aspects and mechanisms underlying the implementation degree. We found that prioritization, synergy with parallel change processes, and intervention fit, were decisive mechanisms for the successful implementation of the intervention. We also found that lack of resources (staff instability, insufficient time, poor mental resources) and resource-demanding parallel change processes, were contextual aspects that “blocked” all mechanisms. That is, when resources were not available, none of the mechanisms for implementing the intervention was activated. Our findings point to the importance of investigating the role of contextual aspects when assessing the effectiveness of organizational interventions

Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework

in 2009, the European Association for Palliative Care (EAPC) developed a framework on palliative sedation, acknowledging this practice as an important and ethically acceptable intervention of last resort for terminally ill patients experiencing refractory symptoms. Before and after that, other guidelines on palliative sedation have been developed in Europe with variations in terminology and concepts. As part of the Palliative Sedation project (Horizon 2020 Funding No. 825700), a revision of the EAPC framework is planned. The aim of this article is to analyze the most frequently used palliative sedation guidelines as reported by experts from eight European countries to inform the discussion of the new framework. The three most reported documents per country were identified through an online survey among 124 clinical experts in December 2019. Those meeting guideline criteria were selected. Their content was assessed against the EAPC framework on palliative sedation. The quality of their methodology was evaluated with the Appraisal Guideline Research and Evaluation (AGREE) II instrument. Nine guidelines were included. All recognize palliative sedation as a last-resort treatment for refractory symptoms, but the criterion of refractoriness remains a matter of debate. Most guidelines recognize psychological or existential distress as (part of) an indication and some make specific recommendations for such cases. All agree that the assessment should be multiprofessional, but they diverge on the expertise required by the attending physician/team. Regarding decisions on hydration and nutrition, it is proposed that these should be independent of those for palliative sedation, but there is no clear consensus on the decision-making process. Several weaknesses were highlighted, particularly in areas of rigor of development and applicability. The identified points of debate and methodological weaknesses should be considered in any update or revision of the guidelines analyzed to improve the quality of their content and the applicability of their recommendations

"Never at ease" - family carers within integrated palliative care: a multinational, mixed method study

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