Aim: The purpose of this article was to explore workplace routines and strategies for preventing and managing bullying in the context of health and elderly care. Background: Bullying is a serious problem in workplaces with consequences for the individual, the organisation and the quality of care. Method: Open-ended interviews were conducted with 12 participants, including managers and specialists within one hospital and three municipalities. The interviews were analysed with qualitative content analysis. Results: Bullying was often concealed, due to avoidance, unclear definition and lack of direct strategies against bullying. No preventative work focusing on bullying existed. Psychosocial issues were not prioritized at workplace meetings. The supervisor had the formal responsibility to identify, manage and solve the bullying problem. The most common decision to solve the problem was to split the group. Conclusions: The findings showed that bullying was a concealed problem and was first acknowledged when the problem was acute. Implications for Nursing Management: Crucial strategies to prevent and combat bullying consist of acknowledgement of the problem, transformational leadership, prioritization of psycho-social issues, support of a humanistic value system and work through bullying problems to achieve long-term changes. © 2018 John Wiley & Sons Ltd

Whole-system approaches linking workplace health promotion to the development of a sustainable working life have been advocated. The aim of this scoping review was to map out if and how whole-system approaches to workplace health promotion with a focus on management, leadership, and economic efficiency have been used in Nordic health promotion research. In addition, we wanted to investigate, in depth, if and how management and/or leadership approaches related to sustainable workplaces are addressed. Eighty-three articles were included in an analysis of the studies' aims and content, research design, and country. For a further in-depth qualitative content analysis we excluded 63 articles in which management and/or leadership were only one of several factors studied. In the in-depth analysis of the 20 remaining studies, four main categories connected to sustainable workplaces emerged: studies including a whole system understanding; studies examining success factors for the implementation of workplace health promotion; studies using sustainability for framing the study; and studies highlighting health risks with an explicit economic focus. Aspects of sustainability were, in most articles, only included for framing the importance of the studies, and only few studies addressed aspects of sustainable workplaces from the perspective of a whole-system approach. Implications from this scoping review are that future Nordic workplace health promotion research needs to integrate health promotion and economic efficiency to a greater extent, in order to contribute to societal effectiveness and sustainability.

The aim of the present study was to explore preventive strategies and processes to counteract bullying in workplaces. Data were collected by individual interviews and focus group discussions at one hospital and two nursing home wards for elderly, a total of 29 participants. In the analysis of the interviews we were inspired by constructivist grounded theory. Persistent work with a humanistic value system by supervisor and coworkers, raising awareness about the bullying problem, strong group collaboration, and conflict management, along with an open atmosphere at the workplace, appears to be imperative for accomplishing a policy of zero tolerance for bullying.

Background: Qualitative methods such as phenomenology and grounded theory have been valuable tools in studying public health problems. Aim: A description and comparison of these methods. Results: Phenomenology emphasises an inside perspective in form of consciousness and subjectively lived experiences, whereas grounded theory emanates from the idea that interactions between people create new insights and knowledge. Fundamental aspects of phenomenology include life world, consciousness, phenomenological reduction and essence. Significant elements in grounded theory are coding, categories and core categories, which develop a theory. Conclusions: There are differences in the philosophical approach, the name of the concept and the systematic tools between the methods. Thus, the phenomenological method is appropriate when studying emotional and existential research problems, and grounded theory is a method more suited to investigate processes. © 2015 the Nordic Societies of Public Health.

Aim: Our objective was to develop and implement an intervention program in collaboration with workplace personnel, to evaluate the process as a vehicle to prevent and combat bullying. Methods: The project emanates from a community-based participatory approach. We obtained data from individual and focus group interviews. We used grounded theory methodology, and made a comparative analysis before and after the intervention. Results: Focus group interviews at the three first meetings indicated that those best positioned to prevent and combat bullying were the immediate supervisors, in collaboration with co-workers and upper management. The goal of zero tolerance toward bullying can be achieved if all concerned work together, using a humanistic value system, an open workplace atmosphere, group collaboration and conflict resolution. We developed an intervention, including lecturers and reflection groups, which ultimately resulted in an action plan. Focus group interviews at the fourth meeting, after the implementation, showed that employees were then more aware of bullying problems; the atmosphere at the workplace improved; the collaboration between and within the group was stronger; and the supervisor worked continuously to prevent and combat bullying, using the humanistic values suggested. We propose additional systematic work to implement our action plan and a conflict resolution system. Conclusions: The anti-bullying program implementation in the workplace achieved some success, but the intervention process is ongoing.

The aim of this study was to explore the development of interprofessional collaboration aiming to improve secondary prevention of osteoporosis by studying this topic expansively from the perspectives of different stakeholders. The method used was a longitudinal single case study with both qualitative and quantitative data sources. The findings elucidate that the bottom-up structure used triggers a freedom to act for the professionals and a changed leadership. Such an approach seems to make managers aware of the need for a horizontal organizational focus that, in this case, was crucial for developing interprofessional collaboration. Furthermore, the study shows that continuous feedback was central to motivate professionals to collaborate. Constructive feedback was created by interprofessional and patient-centered interaction skills, facilitated by confirming leadership promoting ability to recognize the efficacy of joint collaboration. The interprofessional collaboration resulted in an improved chain of care with increased transparency and collective control with benefits for both patients and providers. Outcomes at the system level showed an appreciable increase in patients investigated for osteoporosis: 88% were followed up in primary care and nearly half had improved their health behavior. The implementation of a bottom-up structure where leaders and professionals are developing interdependency, measuring collective performance and using feedback loops generated, in this case, motivational forces for interprofessional collaboration. It is reasonable to assume that these findings could be transferable to similar healthcare settings. Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2012.724123?prevSearch=allfield%253A%2528Hjalmarson%2529&searchHistoryKey=

The aim of this study was to explore the development of interprofessional collaboration aiming to improve secondary prevention of osteoporosis by studying this topic expansively from the perspectives of different stakeholders. The method used was a longitudinal single case study with both qualitative and quantitative data sources. The findings elucidate that the bottom-up structure used triggers a freedom to act for the professionals and a changed leadership. Such an approach seems to make managers aware of the need for a horizontal organisational focus which, in this case, was crucial for developing interprofessional collaboration. Furthermore, the study shows that continuous feedback was central to motivate professionals to collaborate. Constructive feedback was created by interprofessional and patient-centered interaction skills, facilitated by confirming leadership promoting ability to recognise the efficacy of joint collaboration. The interprofessional collaboration resulted in an improved chain of care with increased transparency and collective control with benefits for both patients and providers. Outcomes at the system level showed an appreciable increase in patients investigated for osteoporosis: 88% were followed up in primary care and nearly half had improved their health behaviour. The implementation of a bottom-up structure where leaders and professionals are developing interdependency, measuring collective performance and using feedback loops generated, in this case, motivational forces for interprofessional collaboration. It is reasonable to assume that these findings could be transferable to similar health care settings.

Keywords: interprofessional collaboration, bottom-up approach, case study, secondary prevention and osteoporosis

Purpose – The purpose of this paper is to explore interprofessional experiences of incorporating fracture prevention activities in clinical practice inspired by an empowerment approach.

Design/methodology/approach – Data collection consisted primarily of focus groups interviews, systematized and analyzed by the grounded theory method. The study took place in a health-care district in a county in Sweden and involved health professionals from primary health care and orthopaedic departments.

Findings – The findings generated the core category forming a learning culture in managing to incorporate fracture prevention activities in clinical practice. In this learning culture, new forms of interaction with patients were practised and the collaboration developed between multidisciplinary teams added meaning and triggered personal and collective learning in particular about the need for breaking professional patterns, creating more empowering meetings, making the preventive links visible and constructing a greater sense of prevention within the community.

Practical implications – The findings show that learning processes through patient-centred interaction and face-to face collaboration based on the professionals' own requests and experiences can be an important motivator to promote fracture prevention activities.

Originality/value – This study provides some interprofessional elements in achieving a learning culture concerning health education and fracture prevention.

Integrating an action program in daily practice to stop and prevent bullying

Background & Context: Bullying is a public health problem that negatively affects health at workplaces. In the public sectors, including health care, it is more common with bullying problems compared to other sectors. Earlier research has primarily focused on incidence, prevalence, risk factors and relationships between bullying and ill-health.  To a much lesser degree, research has focused on prevention. The aim of this study was to develop and implement an intervention to stop and prevent bullying at workplaces in collaboration with employees.

Methodology

This intervention study is integrated in a larger research project. Based on results from questionnaires targeting bullying, three workplaces in the healthcare sector were invited to participate. After approval from superiors, employees were invited to participate in focus-groups (FG), resulting in groups of 6-8 participants at one psychiatric ward in a county council, and two elderly care wards in respective municipalities. FG interviews were conducted twice; the first interview captured views on bullying, the second interview prepared for and developed the intervention. No superior participated in the first interview in order to have employees feel free expressing their views. Instead the department head was interviewed individually. The second included both employees and department heads. The FG interviews were analysed according to Grounded Theory.

Findings: The first interview revealed that the employees had insufficient knowledge about bullying and how to manage it. The second FG demonstrated that there were insufficient opportunities for reflections about bullying problems.  Employees also expressed that they did not feel recognized and valued by superiors in higher levels of the organization.

Given this, the researchers have, as part of the intervention, held half-day lectures on the phenomena of bullying, conflict management, communication and shame. The intervention also contained discussions in small groups focused around game-cards that were specifically designed to initiate discussions about specific situations where bullying may occur and how one may prevent or manage this.

In the FGs, it was furthermore suggested to write a contract that ensured that everyone treats each other with tolerance and respect at the workplace. Both interviews revealed that managers play key roles in preventing workplace bullying.  Appropriate leadership creates safety at the work-places, whereas inappropriate leadership creates fear.

Building on these findings from the FGs, next steps include plan of action, targeting e.g., compulsory, continuing discussions concerning bullying improved contact with the superior level and a workplace contract of mutual respect.

Suggestions for the action plan will be discussed in one additional FG, upon which the plan will be introduced to the directors of the workplaces for their support.

 In summary the results of the findings are a developed intervention/action program consisting of lectures, game card-discussions and an action plan in collaboration with employees and managers.

 Implications for practice, training and organization: 

Systematic longitudinal workplace interventions is one way of shouldering the responsibility of tackling bullying in workplaces, highlighting this often hidden problem.

3 learning objectives:

• Bullying in the workplace is prevalent, and yet  not acknowledged
• Managers play key roles in preventing workplace bullying
• Leadership can contribute to safety as well as fear in the workplace