Bakgrund: Hög arbetsbelastning i kombination med brist på kompetent personal kan leda till hög grad av stress och är ett problem som idag hotar den svenska sjukvården. Arbetsrelaterad stress kan leda till en etisk stress hos sjuksköterskan, som riskerar att inte få tillräckligt med tid för sina patienter. Detta kan i sig riskera patientsäkerheten. Tidigare forskning visar på att fysisk aktivitet har en god påverkan på den mentala hälsan och kan fungera preventivt mot stress.  Syfte: Syftet var att undersöka om det finns skillnader i arbetsrelaterad stress bland sjuksköterskor som utövar fysisk aktivitet i högre respektive lägre grad. Metod: En icke-experimentell tvärsnittsstudie med kvantitativ ansats har genomförts. Enkäten som utgjordes av Perceived Stress Scale-10 och Saltin-Grimby Physical Activity Scale distribuerades som en webbenkät på två sjukhus i södra Sverige. Totalt svarade 19 sjuksköterskor på enkäten vilket resulterade i en svarsfrekvens på 10,8 procent.  Resultat: Majoriteten av deltagarna utövade någon form av fysisk aktivitet på fritiden och baserat på svaren gick det att se en generellt låg grad av arbetsrelaterad stress. Gruppen som angav lägre fysisk aktivitet upplever högre grad av arbetsrelaterad stress än den gruppen som angav högre fysisk aktivitet. Slutsats: Det finns skillnader i arbetsrelaterad stress mellan grupperna som utövar fysisk aktivitet i lägre respektive högre grad. På grund av låg svarsfrekvens och därmed litet datamaterial är det svårt att dra generella slutsatser kring resultatet. Trots detta antyder ändå resultatet att det finns en skillnad i arbetsrelaterad stress mellan sjuksköterskor som utövar fysisk aktivitet i lägre respektive högre grad.

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This research focuses on the concept of occupational stress. Theories and models are discussed in an attempt to highlight the nature of stress and its implications for the individual if it is not effectively managed. Individual differences in the way they experience strain and cope with stress are considered, as well as the organisational implications of stress. Current thinking in the management of stress programmes is highlighted. The empirical study was conducted to determine whether there are differences between various organisational subgroups with regard to variables relating to occupational stress, strain and coping, as measured by the Occupational Stress Inventory - Revised (Osipow, 1998). The findings of the study show that there are significant differences between seniority, age, race and gender subgroups within the accounting organisation in which the research took place, with regard to stress, strain and coping / Industrial Psychology / M.A. (Industrial and Organisational Psychology)

Well-being is fundamental for health. However, health and well-being are under threat by increased prevalence of depression and physical inactivity. Interaction with the natural environment may prevent these critical health issues, as research has shown that walking outdoors contributes to better well-being than walking indoors. The aim of this thesis was to investigate outdoor group walks as a potential public health intervention to enhance positive mental and emotional well-being, reduce stress, and foster resilience. This thesis evaluated Walking for Health, a national group walking programme in England using a nonexperimental, longitudinal design. Individuals who did (Group Walkers) and did not (Non-Group Walkers) take part in outdoor group walks completed two online questionnaires about their mental and emotional well-being, and covariates. To gain a broader understanding of how outdoor group walks may contribute to positive well-being, integrations were proposed between the Attention Restoration Theory and the psycho-evolutionary model, and the theories of coping and resilience. Findings show that Group Walkers had greater mental well-being and positive affect, and less negative affect, depression and perceived stress than Non-Group Walkers. Group walking had no affect on social well-being, connectedness to nature or resiliency. Outdoor group walk participation affected positive well-being through a decrease in perceived stress, and an increase in physical activity. Group Walkers demonstrated resilience against adversity on negative affect. No evidence of resilience from outdoor group walks was found for mental well-being, positive affect or depression. Group walks in farmland and green corridor environments may further boost mental well-being, and reduce negative affect and perceived stress, when compared to group walks in the urban environment. This research suggests that outdoor group walks are effective at improving mental and emotional well-being, and could be a useful public health intervention to reduce stress and foster resilience. Implications for theory are discussed.

As a result of structural changes in the global economy, many organisations are faced with changing workforce demographics. The global workforce is changing not only in terms of age and race, but also in terms of gender (International Labour Office, 2009). This change is referred to as the feminization of labour, and it poses many challenges to organisations as women are entering careers that have previously been predominated by men such as medicine, pharmacy, accounting, engineering and mining (Blau & Kahn, 2000). The retention of women in atypical careers has become a growing concern, as these women are often faced with challenges in the workplace, such as sexual discrimination, hostility and resentment from their co-workers, and physical violence in the workplace (Cognard-Black, 2004). These obstacles encountered by women in atypical positions result in their experiencing difficulty fitting into their groups at work and their organisations as a whole, which increases their turnover intentions (Young & Hurlic, 2007). For effective retention of women in atypical positions in an effort to secure a truly diverse workforce, organisations must be aware of the factors that affect their career decision making. Young and Hurlic (2007) have proposed a model of gender enactment and fit in relation to career decisions of women in atypical positions. They suggest that gender enactment of employees in atypical positions, in relation to the gender-based micro-culture of their work groups ultimately affects their person-group fit, person-organisation fit and career decision making. The main objective, therefore, of this research has been to explore the constructs outlined in the model of Young and Hurlic (2007) within the South African context and to establish their influence on the career decision making of a sample of South African employees in atypical positions. The research has been explorative in nature, and a qualitative design was used to achieve the research objectives. Participants were invited to participate in the research on a voluntary basis, and they were selected by means of a purposive sampling method. Criteria that were decided upon for the selection of participants were that participants needed to be female, permanently employed and occupying atypical occupations within the same organisation. Based on these criteria, a total population of ten employees was included in the research study (N=10). Qualitative data was collected by means of unstructured and semi-structured interviews. The results indicated that awareness, group acceptance, person-group fit, perceived stress, and person-organisation fit were the key determinants of the career decisions of participants. Awareness was found to be related to group acceptance, whereas group acceptance was identified as being related to person-group fit. Person-group and person-organisation fit were found to result in participants considering lateral career moves, choosing to stay in their current positions, or seeking promotions. Conversely, perceived stress was found to have a negative impact in the career decision making of participants, as all participants who reported perceived stress planned to leave their respective organisation. / MA, Industrial Psychology, North-West University, Vaal Triangle Campus, 2012

I Sverige upplever sjuksköterskor höga nivåer av psykosociala arbetsmiljörelaterade besvär. Kliniskt ledarskap är ett relativt nytt, obeforskat begrepp som syftar till att identifiera ledarskapsbeteenden hos sjuksköterskor. Det saknas dock forskning om dess eventuella samband med psykosociala arbetsmiljöfaktorer. Föreliggande studies syfte är därför att undersöka hur upplevd stress, arbetskrav och work-family conflict predicerar kliniskt ledarskap hos sjuksköterskor i offentlig vård. För att undersöka detta svarade 239 sjuksköterskor på en webbenkät, där de skattade sin upplevda stress, arbetskrav, work-family conflict och kliniska ledarskap. Arbetsmiljövariablerna användes som prediktorer i en standard MRA med kliniskt ledarskap som utfallsvariabel. Resultaten visade att modellen förklarar 9,5 % av kliniskt ledarskap, där upplevd stress och känslomässiga krav är signifikanta enskilda prediktorer. Resultaten diskuteras bland annat utifrån tidigare forskning om stress, eget ledarskap och kliniskt ledarskap samt arbetskrav utifrån krav-kontroll modellen. / In Sweden, nurses experience high levels of troubles related to the psychosocial work environment. Clinical leadership is a new concept, which aims to identify leadership behaviors for nurses. However, there is a lack of studies about its possible relationship with psychosocial work environmental factors. Therefore, the purpose of this study was to investigate how perceived stress, work demands and work-family conflict predict clinical leadership in nurses in public sector health care. In this study, 239 nurses participated in a web-based questionnaire, where they rated perceived stress, work demands, work-family conflict and clinical leadership. The work environment variables were used as predictors in a standard MRA with clinical leadership as the dependent variable. Results showed that the model explained 9,5 % of clinical leadership, with perceived stress and emotional demands as significant predictors. Findings are discussed based on previous research on stress, self-leadership and clinical leadership, and job demands based on the Demand-Control model.

Integrative Medicine (IM) is a care approach that focuses on the overall well-being and healing process of patients rather than solely on their disease. IM educates and empowers people to be active players in their own care, emphasizes the therapeutic relationship, and makes use of all appropriate evidence-based approaches. The health-oriented foundations of IM are in line with the recently posed concept that describes health as ”the ability to adapt and to self-manage”. Due to the shared underpinnings of both IM and the new concept of health, incorporation of this new concept of health may serve as a facilitator for the development and implementation of IM. From a practical viewpoint, working from an integrative care approach requires specific competences from healthcare providers, such as socio-communicative and self-reflective skills, and reflexivity towards a holistic perspective on health. Previous studies have shown that a Mind-Body Medicine (MBM) course can potentially foster these competences among future healthcare providers. This thesis intended to gain increased insight into the prerequisites and tools for implementation of IM. Therefore, in the first part it aimed to explore the attitudes and practice of IM among Dutch nurses and the support for the new dynamic concept of health as ”the ability to adapt and to self-manage” among main stakeholders within the Dutch healthcare community. Furthermore, in the second part it aimed to evaluate the possibilities of an MBM course among medical and nursing students as a tool to foster an integrative care approach. Methods Both quantitative and qualitative research designs were used. Attitudes and practice of IM were assessed in a semi-structured survey study among 355 Dutch nurses (study I). Support for the new concept of health was explored in a mixed method study, where in the first step data from interviews and focus-groups among 140 stakeholders were investigated by use of manifest content analysis, and in the second step a cross-sectional survey was performed among 1938 stakeholders to verify the findings of the first step (study II). The MBM course was evaluated by a controlled, quasi-experimental intervention study (74 participants / 61 controls among medical students and 47 participants / 64 controls among nursing students) in which validated questionnaires were used (study III). Furthermore, in-depth interviews with 11 medical and 15 nursing students were employed and analysed by a Phenomenological Hermeneutical method to obtain an in-depth understanding of the meaning of the MBM course for the participants (study IV). Findings Study I showed an overall positive attitude towards IM among nurses. Patient-centeredness and a focus on individuals’ own resources and responsibility to promote health met the most support among both nurses and other stakeholders. These elements were considered to be the main positive aspects of the new dynamic concept of health among stakeholders as well (study II). Use of evidence-based and safe complementary therapies and a healing environment received some support from the nurses, but lack of knowledge and lack of evidence seems to hinder further incorporation in the current healthcare practice (study I). Additionally, study II revealed that health was perceived to comprise six dimensions: bodily functions, mental functions &amp; perception, spiritual / existential dimension, quality of life, social and societal participation and daily functioning. In line with patients, nurses had a more broad conception of health in comparison to other healthcare professionals. Study III showed long-term beneficial effects of the MBM course on two dimensions of empathy (personal distress and empathic concern) among medical students, and on perceived stress and empathy (personal distress) among nursing students. Study IV brought forth that the MBM course can be understood as a pathway to inner awareness and a support to connecting with others as well as the outside world. The following themes were identified: “ability to be more present”, “an increased perception and awareness of self”, and “connecting on a deeper level with others”. Conclusion It can be concluded from the results in the first explorative part of this thesis that the observed positive attitudes and perceptions among healthcare professionals toward IM and the newly proposed health concept can serve as important facilitators for further implementation of IM within the Dutch healthcare system. Furthermore, the increased ability to deal with stress, improved empathic abilities and more openness toward different perspectives on health and new treatment options among medical and nursing students following a MBM course, as reported in the second part of this thesis, suggest that this course might be a suitable tool to foster an integrative care approach among future healthcare professionals. / IM (Integrativ Vård mer adekvat term på svenska) är ett vårdkoncept/vårdansats som mer fokuserar på patienters välmående och läkeprocesser än enbart deras sjukdom. IM överlämnar makten och utbildar individen till att själv bli aktiva i sin vård, den framhäver vikten av en god vårdande relation och använder alla tillämpliga evidensbaserade metoder. Den hälsofrämjande grunden i IM är i linje med ett nyligen utvecklat hälsobegrepp, som beskriver hälsa som ”en persons förmåga till att anpassa sig och hantera utmaningar”. Utifrån den liknande grunden och förutsättningarna hos IM och det nya hälsobegreppet så kan en integration av dem vara en understödjande faktor för utveckling och implementering av IM. Utifrån en praktisk synvinkel så innebär en integrativ vårdansats att den som vårdar måste inneha specifika kompetenser och förmågor relaterade till bland annat socio-kommunikativ och självreflektiv förmåga, såväl som en reflektiv öppenhet till ett holistiskt perspektiv på hälsa. Tidigare forskning har visat att en Mind-Body Medicine (MBM) kurs potentiellt kan understödja utveckling av dessa kompetenser bland framtida vårdare. Denna avhandling avsåg i första hand att uppnå ökad insikt i förutsättningar och verktyg för implementering av Integrativ Vård. Mer specifikt syftade den till att beskriva attityder till, och utövande av IM bland Nederländska sjuksköterskor, samt undersöka stödet för det nya dynamiska hälsobegreppet (”en persons förmåga till att anpassa sig och hantera utmaningar”) bland intressenter inom Nederländsk Hälso- och Sjukvård. Vidare i andra hand, avsåg avhandlingen också att utvärdera förutsättningarna för att använda en MBM kurs som ett verktyg till att understödja och fostra ett mer integrativt förhållningssätt bland läkar- och sjuksköterskestudenter. Metod Både kvantitativ såväl som kvalitativ forskningsdesign tillämpades. Attityder till, och utövande av IM undersöktes i en semistrukturerad enkätstudie bland 355 Nederländska sjuksköterskor (studie I). Stödet för det nya hälsobegreppet undersöktes i en studie som genomfördes med mixad design, där i det första steget data från individuella- och fokusgruppintervjuer bland 140 intressenter genomgick en manifest innehållsanalys, och i det andra steget genomfördes en tvärsnittsstudie bland 1938 intressenter för att validera fynden från det första steget (Studie II). MBM kursen utvärderades i en kontrollerad, kvasi-experimentell interventionsstudie (71 deltagare/61 kontroller bland läkarstudenter, och 47 deltagare/64 kontroller bland sjuksköterskestudenter) med validerade frågeformulär (Studie III). Vidare även i en Fenomenologisk-Hermeneutisk ansats via individuella intervjuer med 11 läkar- och 15 sjuksköterskestudenter för att uppnå en djupare förståelse över MBM kursens betydelse för deltagarna (Studie IV). Fynd I studie I framkom att sjuksköterskorna övergripande hade en positiv attityd till IM. Patientcentrering och fokus på individens resurser, samt deras egna ansvar för att arbeta hälsofrämjande var områden som hade mest stöd bland både sjuksköterskor och andra intressenter. Dessa element ansågs också av intressenterna vara den mest positiva aspekten av det nya dynamiska hälsobegreppet (Studie II). Användandet av evidensbaserade komplementärmedicinska metoder och hälsofrämjande miljöer stöddes till viss del av sjuksköterskorna men brist på kunskap och brist på evidens förefaller vara hinder för integration i nuvarande vårdpraxis (Study I). I studie II framkom att begreppet hälsa uppfattades som att bestå i sex olika dimensioner; ”kroppslig funktion”, ”mental funktion och perception”, ”spirituell/existentiell dimension”, ”livskvalitet”, ”social-samhällelig inklusion” samt ”daglig funktion”. I samklang med patienter, så hade sjuksköterskor en bredare syn på hälsa än andra hälsoprofessioner. I studie III framkom långsiktiga positiva effekter av att delta i MBM kursen avseende i två dimensioner av empatisk förmåga (Personal distress och Empatic concern) bland läkarstudenterna, samt avseende upplevd stressnivå (perceived stress) och empati (personal distress) bland sjuksköterskestudenterna. I studie IV framkom att MBM kursen kan ses som ”en väg till inre medvetenhet och stöd till att knyta an till andra och den omgivande världen” vidare identifierades temana: ”en förmåga till en mer medveten närvaro”, ”en ökad uppfattningsförmåga och inre medvetenhet” samt ”att knyta an till andra människor på en djupare nivå”. Slutsats Utifrån resultaten i avhandlingens explorativa (I, II) del är slutsatsen att de observerade positiva attityderna, och uppfattningarna bland vårdgivare avseende IM och det nyutvecklade hälsobegreppet kan ses som viktiga facilitatorer för ytterligare implementering av IM i det Nederländska hälso- och sjukvårdssystemet. Vidare, den ökade förmågan att hantera stress, utveckla empatisk förmåga och mer öppenhet för nya perspektiv på hälsa och behandlingsalternativ hos läkar- och sjuksköterskestudenter efter deltagande i en MBM kurs (implementeringsdelen i denna avhandling, III, IV), stöttar antagandet att kursen kan ses som ett användbart verktyg för att understödja en mer integrativ vårdansats bland framtida vårdpersonal. / <p>Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 3 i tryck, delarbete 4 inskickat.</p><p>At the time of the doctoral defence the following papers were unpublished: paper 3 in press, paper 4 submitted.</p>

Syftet med denna studie var att undersöka äldre människors (pensionärers) välmående genom att analysera samband mellan upplevd stress, självkänsla och livstillfredställelse i relation till kön, ålder, utbildningsnivå och civilstånd. Studien grundades på en enkätundersökning där 91 äldre individer deltog. Enkäten konstruerades med hjälp av skalorna Perceived Stress Scale (PSS) som mäter stress, Rosenbergs Self-Esteem Scale (RSES) som mäter självkänsla och Satisfaction With Life Scale (SWLS) som mäter livstillfredsställelse. Resultaten visade att det fanns signifikant samband mellan upplevd stress, självkänsla och livstillfredsställelse samt signifikanta skillnader mellan män och kvinnor gällande stress och livstillfredsställelse. Kvinnliga deltagare upplevde mer stress, hade lägre livstillfredsställelse och självkänsla än män. Resultaten visade att kön, livstillfredsställelse och självkänsla signifikant predicerar stress. / The aim of the study was to examine wellbeing of older people (pensioners)by analyzing the relationship between perceived stress, self-esteem and life-satisfaction in relation to gender, age, educational level and marital status. The study was based on a survey where 91 older individuals participated. The survey included Perceived Stress Scale (PSS) measuring stress, Rosenberg’s Self-Esteem Scale (RSES) measuring self-esteem and Satisfaction With Life Scale (SWLS), measuring life satisfaction. The results showed that there were significant relationships between perceived stress, self-esteem and life satisfaction, as well as significant differences between men and women regarding stress and life satisfaction. Females experienced more stress, had lower life satisfaction and self-esteem than males. The results also showed that gender, life satisfaction and self-esteem significantly predict stress.

Contexte : Les étudiants universitaires représentent la catégorie la plus touchée par le stress, la détresse psychique et leurs conséquences (physiques et psychiques). Ils sont plus vulnérables aux troubles psychiques que la population générale et que les autres étudiants en raison des nombreux changements et des responsabilités qui accompagnent la période d’étude à l'université. Cette thèse a pour but, d’une part, de mieux comprendre le mal-être psychologique des étudiants universitaires, et, d’autre part, de se pencher sur les actions pouvant être menées pour faire face à ce problème. Format de la thèse : Cette thèse s’articule en deux axes. Le premier axe porte sur l’évaluation de la santé mentale, et notamment du stress, auprès d’un échantillon d’étudiants universitaires (Partie I : Santé mentale chez les étudiants universitaires: perspectives théoriques et études empiriques). Le deuxième axe porte sur l’élaboration et l’évaluation d’une intervention de gestion du stress menée auprès de ces étudiants (Partie II : Gestion du stress chez les étudiants : perspectives théoriques et études empiriques). Pour chaque axe, une revue de la littérature sur les concepts étudiés, ainsi qu’une revue des études empiriques ont été menées sous forme d’articles (publiés ou en cours).Le but de cette dissertation est donc double et s’articule autour de dix articles ;Conclusion: Malgré certaines limites, nos résultats constituent des apports nouveaux et prometteurs sur la gestion du stress via internet pour les étudiants universitaires. Cette proposition d'intervention via internet pourrait s'adresser particulièrement aux étudiants qui ne consultent pas. / Context: University students are the most affected by stress, psychological distress and their consequences (physical and mental). They are more vulnerable to mental disorders than the general population and other students because of the many changes and responsibilities that come with studying at the university. On the one hand, this thesis aims to better understand the psychological ill being of university students, and on the other hand, to look at ways to face this problem.Format of the thesis: This thesis is articulated in two axes. The first focuses on the evaluation of mental health, including stress, among a sample of university students (Part I: Mental Health among University Students: Theoretical Perspectives and Empirical Studies). The second focuses on the development and the evaluation of a stress management intervention for these students (Part II: Students Stress Management: Theoretical Perspectives and Empirical Studies). For each, a review of the literature on the concepts studied, as well as a review of empirical studies, was conducted in the form of articles (published or in progress). The purpose of this dissertation is therefore dual and is articulated around ten articles;Conclusion: Despite some limitations, our results constitute new and promising contributions on stress management online for university students. This proposal for an intervention online could be particularly aimed at students who do not consult.

Syftet med detta examensarbete är att undersöka elevers upplevda stress och deras tillvägagångssätt för att hantera denna stress med hjälp av copingstrategier, vilket sedan sätts i relation till biologiskt kön. Arbetet utgår ifrån ett elektroniskt frågeformulär som inkluderar både kvantitativa och kvalitativa aspekter. Resultaten av denna studie visar sig i några fall avvika från den tidigare forskningen, vilket leder till intressanta analyser och diskussioner. Ett av dessa resultat är pojkarnas användande av emotionsfokuserade copingmetoder, som annars är färre än flickornas. Ett annat intressant och avvikande resultat är stressnivåerna inom gruppen flickor, då det visar sig att de som går ett yrkesförberedande program procentuellt är mer stressade än högskoleförberedande programmets flickor. / The purpose of this study is to examine students experienced stress and their ways of coping with that stress using coping strategies, which is later also put in relation to biological sex. The study is using a mixed method in the form of an electronic questionnaire. The results of this study turned out to deviate from previous research, which leads to interesting analyzes and discussions. One of these results is the boys’ usage of emotion-focused coping methods, which otherwise is fewer than the girls. Another interesting and deviating result is the stress levels within the girls’ group, since it turns out that girls who attend a profession-based program are more stressed, percentage wise, than the girls who attend a college-based program.