The psychosocial work environment of district nurses in Sweden

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Abstract
Data were collected from a stratified sample of district nurses in the greater Stockholm area on four occasions during one year using questionnaire techniques (to assess psychosocial working conditions and social networks, and self-reported health sums); as well as physiological measurement techniques. Three groups of district nurses were compared: group A, those working independently in the ‘traditional’ role but outside primary health care centres; group B, those working independently in the ‘traditional’ role but in primary health care centres; and group C, those working in the model role as part of primary health care teams. The study focused on the effects of these different work environments on the district nurse's psychological and somatic health, and their physiological state. The data suggested that district nurses in the primary care teams (group C) had a lower objective work load than those working in the more traditional role. Despite this, they reported a less favourable balance (ratio) of work demands to decision latitude. They reported more ‘problems’ and ‘conflicts’ at work than did the other district nurses. However, such ‘problems’ were diminishing during the study period, which could mean that successive adaptation to the ‘new’ situation was occurring. The ‘conflicts’, on the other hand, remained. This may indicate that despite this adaptation, the district nurses in the primary care teams were struggling with their new work roles. It points to the need for organizational support during this important change process. The district nurses in group B (traditional role but in a primary health care centre) had the highest objective work load and showed physiological reactions in terms of elevated plasma cortisol levels in the morning, high systolic blood pressure and sleep disturbances.

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