Engagement in health and health in engagement: Examining the antecedents and outcomes of work engagement among nursing home staff

Abstract

Background: An organisational imperative in healthcare worldwide, but especially in the West, is how to meet the needs of an elderly cohort, which rapidly increases in both population proportion and absolute numbers. In line with these projections comes an increased need for nursing homes offering long-term healthcare services to older people. Increased demand for long-term eldercare services means increased needs for qualified staff. However, concomitant with a growing ageing population is a decrease in the working-age cohorts from which are drawn healthcare workers. At the same time, governments and healthcare systems expect staff and organisations to provide person-centred care of high quality. Thus, globally, healthcare systems are under utmost pressure.

Ensuring the provision of high-quality healthcare services for the future requires targeted short- and long-term approaches aimed at building the workforce capacity and the organisation and finances of the healthcare system. Healthcare workers’ well-being and functioning affect the quality of the services, both directly and indirectly. To provide personcentred care, employees must be attentive and sympathetically present, able to engage authentically, and committed to their job. Motivated and healthy employees are more likely to be productive workers, leading to an efficient and successful enterprise. In healthcare, work engagement is found to be associated with increased employee well-being, work effectiveness and work productivity, reduced employee turnover intentions, higher career and job satisfaction, and improved quality of care and user satisfaction. Increasing employees’ work engagement thus represents a promising opportunity for nursing homes aiming for providing high-quality person-centred services. However, the research evidence on the working environment conditions that boost work engagement in the nursing home setting is sparse and ambiguous.

Aim: The main aim of this thesis was to gain in-depth knowledge about the antecedents and outcomes of work engagement among nursing staff (healthcare assistants, licensed practical nurses, and registered nurses) working in nursing homes. Of special interest was examining the role of work engagement in the development of person-centred processes.

Materials and methods: The aims of this thesis were addressed through a qualitative study (Study I), a quantitative study (Study II), and a systematic review (Study III).

Study I was a qualitative semi-structured interview study with an explorative descriptive design. It involved digital interviews with sixteen nursing home staff: eight registered nurses, five licensed practical nurses, and three nursing assistants. The study examined the nursing staff’s experiences with work engagement as a motivational state and investigated its environmental antecedents. Moreover, the study examined the association between work engagement and the development of person-centred processes. The Stepwise-Deductive- Inductive (SDI) approach was used to analyse data.

Study II was a quantitative study with an analytical observational and cross-sectional design. Data from 128 nursing home staff was collected in paper-based questionnaires. Two multivariable regression models – one testing the mediation effect and another testing the moderation effect – were used to examine the role of work engagement in the relationship between job resources and demands on the one hand and person-centred processes on the other.

Study III was a systematic review. The study was carried out to synthesise available data from empirical studies examining work engagement among nursing home staff, using the systematic review methodology described by PRISMA. Due to the great diversity in the antecedents and outcomes of work engagement measured, a meta-analysis of effect estimates was not feasible.

Main results: The interview study showed that various conditions in the working environment play a role in increasing nursing home staff’s work engagement. Examples are job feedback, support from colleagues and managers, meaningful work, opportunities for learning and development, and having engaged colleagues. Moreover, the interview study showed that elevated physical, cognitive, and mental capacity from work engagement can play a role in developing person-centred processes.

The questionnaire study showed that job autonomy, meaningful work, development opportunities, and supportive relationships between colleagues are relevant antecedents of nursing home staff’s work engagement. The study showed, however, no positive association between work engagement and person-centred processes.

The review study showed that the most investigated antecedents and outcomes of work engagement among nursing staff exclusively working in nursing homes are, respectively, 1) social support and learning and development opportunities, and 2) person-centred processes. However, the study revealed that the evidence base regarding antecedents and outcomes of work engagement in this working context is ambiguous and sparse and thus does not provide a basis for drawing firm conclusions.

Conclusion: Based on the findings of the three included studies, this thesis emphasises the importance of facilitating the development of working environments that protect and promote the health and well-being of healthcare workers. The findings show that there is an association between, on the one hand, personal, organisational, and psychosocial working environment resources of nursing home staff and, on the other, work engagement and person-centred processes. The findings here suggest as well, albeit ambiguously, that work engagement can facilitate person-centred processes. These results can help orient furtherresearch on the antecedents and outcomes of work engagement among nursing staff exclusively working in nursing homes. Thus, the findings of this thesis are relevant to meeting the challenges of an ageing population and developing high-quality long-term eldercare services.