Bakgrund: Den upplevda arbetsrelaterade stressen bland sjuksköterskor på sjukhus är ett stort problem i hela världen och påverkar sjuksköterskors hälsa samt medför stora risker. Andra typer av konsekvenser kan vara att kvaliteten på omvårdnaden försämras.  Syfte: Att beskriva erfarenheter av arbetsrelaterad stress och utbrändhet bland sjuksköterskor som arbetar på sjukus Metod: Litteraturstudien innefattade tio kvalitativa studier. Vid databassökningen användes Pubmed och Cinahl. Fribergs femstegsmodell användes vid analysprocessen för att analysera studierna.  Resultat: Analysen resulterade i tre kategorier och åtta subkategorier. De tre kategorierna var: 'Att efterfråga tydlighet i vårdstrukturen', 'Känsla av otillräcklighet' och 'Att patientsäkerheten hotas på grund av arbetsbelastningen'. Konklusion: Arbetsrelaterad stress och utbrändhet orsakas av många olika faktorer, allra främst på grund av en bristande organisation. Förbättringsförslag inom det aktuella områden är att utveckla organisationen samt förbättra prioriteringar gällande upplägget av ekonomin. Exempel på förbättringar organisationen kan ordna är teambuildning, tillräckligt med utrustning på plats, fokus på personalvård och tydligare ledarskap. Allt detta bidrar till en bättre arbetsmiljö för sjuksköterskorna men även till en bättre patientvård. / Background: The experience of burnout and work-related stress among nurses at hospitals are a big problem all around the world and affects nurses' health and entails big risks. Consequences of this are that the quality of care can deteriorate.  Aim: To describe experiences of work-related stress and burnout among nurses working in hospitals.  Methods: The literature study is based on ten qualitative studies. Pubmed and Cinahl were used as database search. Friberg's five-step model was used in the analysis process to analyze the studies.  Results: The analysis resulted in three categories and eight subcategories. The three categories were: To demand clarity in the care structure', 'The feeling of inadequate' and 'Patient safety is threatened due to the excessive workload'. Conclusion: Work-related stress and burnout is caused by many different factors, a big reason is an inadequate organization. Suggestions for improvement in this area are to develop the organization and improve priorities regarding the economy. Examples of improvements that the organization can do are teambuildning, enough equipment, focus on the staffcare and clearer leadhership. All this can improve the work environment for the nurses and the patient care.

Forskningsfrågor: 1. Vilka proaktiva åtgärder använder arbetsgivare i förebyggande syfte för att undvika utvecklingen av negativ stress på arbetsplatsen? 2. Vilka reaktiva åtgärder använder arbetsgivare för att hantera redan utvecklad arbetsrelaterad stress hos sina medarbetare?  Syfte: Undersöka de praktiska åtgärder som arbetsgivare använder för att hantera arbetsrelaterad stress. Därmed eftersträvar denna studie till att bidra med en ackumulerad samling av konkreta förslag på åtgärder som kan användas praktiskt i olika arbetsrelaterade sammanhang. Metod: Kvalitativ metod med en abduktiv forskningsansats. Datainsamling genom djupgående semistrukturerade intervjuer som genomfördes en och en. Den primära respondentgruppen var arbetsgivare.  Slutsats: Praktiska åtgärder på proaktiv och reaktiv stresshantering sammanfattas enligt studien genom fyra teman: kommunikation, kunskap, ledarskap och företagskultur. Genom regelbunden kommunikation kan symtom på stress upptäckas i tid och tillsammans med medarbetaren hitta en lösning för återhämtning. Genom planering kan onödig stress undvikas. Kunskap om stress och verktyg för hantering kan med fördel undvika utvecklingen av stress. Förslag på gott ledarskap i stresshanteringssyfte kan handla om närvaro och att visa att man som ledare finns där för att hjälpa medarbetare som drabbas av stress. En öppenhet kring dialoger om stress kan ha betydelse för hur stress kan undvikas och hanteras. En företagskultur som främjar gemenskap i kombination med en öppenhet om stress, kan hjälpa medarbetare att våga be om hjälp när stress upplevs på arbetsplatsen. / Research questions: 1. What proactive measures do employers use preventively to avoid the development of negative stress in the workplace? 2. What reactive measures do employers use to manage already developed negative work-related stress in their employees? Purpose: Investigate the practical measures employers use to manage work-related stress. Thus, this study strives to contribute with an accumulated of concrete proposals for measures that collection can be used practically in various work-related contexts. Method: Qualitative method with an abductive research approach. Data collection through in-depth semi-structured interviews conducted one on one. The primary respondent group was employers. Conclusion: Practical measures on proactive and reactive stress management are summarized according to the study through four themes: communication, knowledge, leadership and corporate culture. Through continuous communication, symptoms of stress can be detected in time and together with the employee, find a solution for recovery. Through planning, unnecessary stress can be avoided. Knowledge of stress and tools for management can advantageously avoid the development of stress. Suggestions for good leadership for stress management purposes can be about presence and showing that you as a leader are there to help employees who are affected by stress. An openness about dialogues about stress can have an impact on how stress can be avoided and managed. A corporate culture that promotes community, combined with an openness about stress, can help employees dare to ask for help when stress is experienced in the workplace.

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<p><strong>ABSTRACT</strong></p> <p>Annually, thousands of immigrant women employed in precarious low-paying jobs become more marginalized after experiencing work-related injuries because they cannot obtain just compensation from Ontario’s Workplace Safety and Insurance Board (WSIB). In 1913 Sir William Meredith attempted to establish an equitable compensation system. Over the decades, and especially in the past 25 years, the influence of neoliberal forces has continued to create a system that resembles a market-based insurance model.</p> <p>Using an institutional ethnographic approach, this research explicates how the policies of the WSIB are implicated in ruling relations. Four immigrant women who had experienced work-related injuries were interviewed. Their experiences of the problematic were mapped to the texts: the Workplace Safety and Insurance Act, the New Experimental Experience Rating and Merit Adjusted Premium Programs, and WSIB’s Forms 6, 7 and 8.</p> <p>The findings indicate that (a) work-related injuries have resulted in the immense social, emotional, moral, financial, and physical degradation of the participants; (b) an important relationship exists between the contents of the texts and the adverse experiences of the participants; (c) the texts influenced the ways that employers, WSIB service and health care providers, and legal professionals responded to the participants; and (d) the texts influenced the women’s experiences of the system and directed the actions that they had to take in very specific ways.</p> <p>This study examined the experiences of this group of women about whose experiences of the system little is known. Although the information that they provided was strong and supported what is already known about how other groups of injured workers experience the system, the small sample size suggests that additional research with a larger sample size is warranted. Because the women’s employers were not interviewed, research on the influence of these texts on the experiences and actions of all stakeholders would add to our knowledge.</p> <p><strong><br /></strong></p> / Master of Social Work (MSW)

Work-related repetitive strain injury (RSI), one of the work-related musculoskeletal disorders, is the most commonly reported occupational illness, yet the pathophysiological mechanisms are not yet clear. Using our unique RSI animal model, pathophysiological tissue responses can be examined simultaneously with behavioral responses that serve as indicators of sensorimotor function. Studies in humans and with this animal model have shown that prolonged performance of repetitive tasks leads to declines in grip strength and increased of serum pro-inflammatory cytokines, both valuable biomarkers of underlying tissue injuries. Identification of biomarkers would help to elucidate the time course of the inflammatory stage of these disorders and disease progression. Sickness responses/behaviors, normal responses and behaviors occurring as a consequence of infection or illness, are responsible for re-organizing perceptions and actions to enable individuals to respond appropriately to the infection, injury and other illnesses. These behaviors can include malaise, fatigue, increased irritability and social withdrawal, behaviors that can be beneficial when ill for avoiding others and enhancing wellness. However, sickness behaviors can also include depression, sleep disorders and an enhanced perception of illness. Although recent studies have shown that circulating pro-inflammatory cytokines in serum may trigger sickness behaviors, only a few studies have examined if there is an association between work-related musculoskeletal disorders and subsets of sickness behavior; no one to date has elucidated any plausible biological cause of this association. Also, the combined effects of both aging and performance of repetitive tasks needs more evaluation since several epidemiological studies have shown a relationship between advancing age and susceptibility to musculoskeletal disorders. Therefore, using female Sprague-Dawley rats, the aims of this dissertation project are to: 1) To determine if a systemic inflammatory response is maintained long-term in rats exposed to a moderate demand lever-pulling task with high repetition, low force (HRLF) requirements; if aging enhances this systemic inflammatory response and if this response correlates with functional motor declines; 2) To determine if performance of repetitive upper extremity tasks leads to the development of sickness behaviors (weight loss, decreased social interaction and increased aggression); 3) To determine if a relationship between repetitive upper extremity tasks lead to the development of dose- and age-dependent sickness behaviors, and, to determine if increased serum or brain inflammatory cytokines are plausible mechanisms for the induction of sickness behaviors in this model; and, lastly, 4) To determine if prophylactic or secondary systemic treatments with anti-inflammatory drugs (anti--tumor necrosis factor alpha or ibuprofen) reduces sickness behaviors in rats performing a high demand high repetition high force (HRHF) reaching and handle pulling task. This finding would be in further support of an underlying task-induced inflammatory mechanism contributing to these sickness behaviors. In the first study, the relationship between serum and grip strength was examined in aged and young adult rats performing a HRLF task. Serum levels of interleukin 1-alpha (IL-1&#945;), interferon-gamma (IFN&#947;) and IL-6 were higher in aged rats in general, compared to young adult rats. Each increased more in aged trained-only and 12-week HRLF rats than in young adult trained-only and 12-week HRLF rats. Serum IL-6 showed the greatest increases, with the highest levels observed in aged 12-week HRLF rats. Grip strength declined with task performance in both age groups; however, this decline correlated negatively and only moderately with serum IL-6 levels in aged rats. Thus, aging enhanced a serum cytokine response in general, a response that was even greater with repetitive task performance. Grip strength was adversely affected by task performance in both age groups, but was apparently influenced by factors other than serum cytokine levels in young rats. In the second study, the relationship between sickness behaviors (weight loss, duration of social interaction and aggression towards novel juvenile rats), serum cytokines and brain cytokines were examined in aged and young adult rats that trained to one of two task levels before performing a HRLF task. Decreased duration of social interaction and increased aggression was greater in both young adult and aged rats that trained for 10 min/day for 4-5 weeks to learn a high force (TRHF) task, compared to young adult and aged rats that learned a low force (TRLF) task. TRHF and TRLF rats of both age groups then performed a HRLF task for 6 to 24 weeks, rats termed TRHF-HRLF and TRLF-HRLF, respectively. Declines in social interaction resolved by week 3 in young adult TRHF-HRLF rats, but were still evident in 6-week aged TRHF-HRLF rats (the final endpoint for TRHF-HRLF rats). Significant increases in aggression were observed only in TRHF-HRLF rats, in both age groups. Declines in social interaction were also observed in aged rats performing a TRLF-HRLF task through week 9, but not in young adult TRLF-HRLF rats, even those performing the HRLF task for 24 weeks. These behaviors correlated moderately with increased serum IL-6 observed in the aged task rats (both TRHF-HRLF and TRLF-HRLF) and young adult TRHF-HRLF rats, although serum TNFalpha and IL-1beta also increased with task performance. Increased IL-6 and IL-6 receptor was detected immunohistochemically in brains of aged TRHF-HRLF rats, specifically in ependymal and endothelial cells, as well as glial cells and neurons of the anterior cingulate cortex and paraventricular nucleus. Thus, training to high force, even for a short time period, induced increased sickness behaviors. Aging contributed to increased sickness behaviors in repetitive task rats, and to increased expression of IL6 and IL-6 receptor in several brain regions. In the third study, the relationships between sickness behaviors (duration of social interaction and aggression towards novel juvenile rats), serum cytokines and brain cytokines were examined in young adult rats performing a high repetition high force (HRHF) task with or without anti-inflammatory medications. Rats that trained to high force (TRHF) had decreased duration of social interaction and increased aggression; these behaviors were prevented by prophylactic anti-TNFalpha or ibuprofen treatment. Untreated TRHF rats that went on to perform a HRHF task showed decreased social interaction and increased aggression through week 12; these behaviors were attenuated by secondary anti-TNFalpha and ibuprofen treatments. Untreated HRHF rats had increased serum GroKC, IFN-gamma, IL-1beta, MIP2, MIP3a and TNFalpha. These increases were attenuated after two weeks of anti-TNFalpha treatment in HRHF weeks 5-6, and after 8 weeks of ibuprofen (in HRHF weeks 5-12). The sickness behaviors correlated moderately with increased serum Gro-KC, MIP2 and TNFalpha, and were concomitant with increased IL-1beta immunoexpression in ependymal and endothelial cells in brains of untreated TRHF and HRHF rats. Both treatments reduced the increased brain IL-1beta expression. Thus, sickness behaviors induced by overuse are attenuated by anti-inflammatory interventions that reduce task-induced increases in systemic and brain inflammatory cytokines. In conclusion, both aging and task performance increased serum inflammatory cytokine responses, the latter in an exposure-dependent manner, with a greater serum cytokine response with performance of high force tasks than low force tasks. While grip strength was adversely affected by task performance in both young and aged rats, it was influenced by factors other than serum cytokine levels. In contrast, decreased duration of social interaction and increased incidence of aggression were influenced by task-induced increases in serum and brain inflammatory cytokines, responses attenuated to baseline levels with systemic anti-inflammatory treatments. Sickness behaviors were also dose- and age-dependent, with higher incidence with performance of high force tasks than with low force tasks, and higher incidence in aged rats. We postulate that the higher incidence in aged rats is due to aged-induced brain "inflamm-aging", as they also had increased immunoexpression of IL6 and IL6 receptor in blood brain barrier cells and in glial and neurons of the hypothalamic pituitary axis. / Physical Therapy

The construction industry, one of the largest employers of labor in the United States, has long suffered from health and safety issues relating to work-related musculoskeletal disorders. Back-related injuries are one of the most prevalent of all musculoskeletal disorders in the construction industry. Due to advancements in the field of wearable technologies, wearable robots such as passive back-support exoskeletons have emerged as a possible solution. Exoskeletons have the potential to augment human capacity, support non-neutral work positions, and reduce muscle fatigue and physical exertion. Current research efforts to evaluate the potential of exoskeletons in other industry sectors have been focused on outcome measures such as muscle activity, productivity, perceived discomfort and exertion, usability, and stakeholders' perspectives. However, there is scarce evidence regarding the efficacy of using exoskeletons for construction work. Furthermore, the risks and sociotechnical challenges of employing exoskeletons on construction sites are not well documented. Thus, through the lens of human-centric and socio-technical considerations, this study explores the prospects of adopting back-support exoskeletons in the construction industry. Firstly, a laboratory experiment was conducted to quantify the impact of using a passive exoskeleton for construction work in terms of muscle activity, perceived discomfort, and productivity. In order to investigate the acceptance of exoskeletons among construction workers and the challenges of adopting exoskeletons on construction sites, field explorations evaluating usability, perceived discomfort and exertion, social influence, and workers user perceptions were executed. Using sequential mixed methods approach, the stakeholders and factors (i.e., facilitators and barriers) critical for the adoption of exoskeletons on construction sites were investigated. Thereafter, by employing the factors and leveraging the constructs of the normalization process theory, an implementation plan to facilitate the adoption of passive exoskeletons was developed. The study contributes to the scarce body of knowledge regarding the extent to which exoskeletons can reduce ergonomic exposures associated with construction work. This study provides evidence of the perceptions of the contextual use of wearable robots, and workers' interaction with wearable robots on construction sites. The study contributes to the normalization process theory by showing its efficacy for the development and evaluation of implementation frameworks for construction industry. Furthermore, this study advances the socio-technical systems theory by incorporating all its subsystems (i.e., human, technology, organization and social) for investigating the potential of using a passive back support exoskeleton in the construction industry. / Doctor of Philosophy / Construction workers are often subjected to harsh working conditions and physically demanding work postures, which are ergonomics risks causing back-related musculoskeletal injuries. These injuries have the potential to cause permanent disabilities, lead to early retirement of experienced labor, and is one of the causes of the shortage of skilled workforce in construction. Wearable robots, such as passive back-support exoskeletons, are increasingly been looked upon as a potential solution to mitigate the problem. Exoskeletons are wearable technologies that can support and reinforce workers' body parts. Studies have shown that the use of exoskeletons could lead to reduced muscle fatigue thereby decreasing injuries in the long run. However, most of the research on the use of exoskeletons is focused on other industrial sectors. Scarce evidence regarding the use of exoskeletons in construction is documented in the literature. Furthermore, the use of exoskeletons on construction sites could have certain unintended consequences. Thus, the objective of this research was to understand the risks and challenges of using passive exoskeletons in the construction industry. A laboratory experiment was conducted to measure the impact of using exoskeletons on physical demand and productivity while performing construction tasks. An increase in productivity and a reduction in discomfort in the lower back were observed while using an exoskeleton. Thereafter, field studies were conducted where construction workers performed their usual tasks using an exoskeleton to understand their user experience and acceptance. To help construction companies in the adoption of exoskeletons, facilitators and barriers to the adoption of exoskeletons were identified. Thereafter a plan was developed to facilitate the implementation of passive exoskeletons in construction organizations. This plan can guide construction companies in the adoption of passive exoskeletons. The outcomes of this study will help other researchers to conduct similar studies with other wearable technologies.

Syftet med studien är att undersöka hur det sociala stödet från chef och kollegor tar sig uttryck, samt dess betydelse för medarbetare vid återgången till arbetet efter en långtidssjukskrivning på grund av arbetsrelaterad stress. Fokus ligger på medarbetarnas upplevelser av det sociala stödet vid återgången, och därför läggs inget vidare fokus på själva sjukskrivningen. Studien har en kvalitativ metodansats där resultatet grundar sig på sju semistrukturerade intervjuer. Vidare har ett hermeneutiskt förhållningssätt i kombination med en abduktiv förståelseansats tillämpats. För att analysera resultaten har teorier och tidigare forskning om socialt stöd, stress och utmattning, kollegialt stöd samt arbetsgivarens stöd använts, där House kategorisering av socialt stöd utgör en central del. Även Habermas teori om system och livsvärld inkluderades för att ge ett ytterligare perspektiv. Resultaten betonar vikten av alla typer av stöd, men där emotionellt och instrumentellt stöd framstår som särskilt viktiga. Vidare varierade både utformningen och källan till stödet, där avsaknaden av socialt stöd var en viktig erfarenhet kopplat till både hur det tog sig uttryck och betydelsen av det. / The purpose of this study is to investigate the significance of social support from managers and colleagues for individuals returning to the workplace after a period of sick leave due to work-related stress. The emphasis is on employees’ experiences of social support as they return and therefore no additional focus is directed toward the sick leave itself. This study is based upon a qualitative research approach with seven semi-structured interviews. A hermeneutic approach combined with an abductive understanding approach has been applied. To analyze the results, theories and previous research on social support, stress and burnout, collegial support, and manager support were studied, with House's categorization of social support being central. Also included is Habermas theory about systems and lifeworld for additional perspective. The results highlight the weight of various types of support, with emotional and instrumental support being of greater importance. Both the design and the source of support varied, and absence of support was an important experience tied to its manifestation and signification.

The work environment constitutes a key social determinant of health, yet previous research is relatively limited vis-à-vis the contribution of both physical and psychosocial work-related stressors on occupational class differences in health among Swedish employees. This study used cross-sectional data from the Swedish Level of Living Survey 2010 to assess the mediating effect of physical and psychosocial work-related stressors to occupational class differences in physical and mental ill health in Sweden. Disparities between gender were also considered. A sub-sample of 2,624 full- and part-time employed individuals aged 18-65 was analysed using logistic regression. Employees who belonged to higher occupational classes had a lower risk of physical ill health compared to employees from lower occupational classes when age, gender and part-time work is accounted for – but there was no evidence of an occupational class gradient in mental ill health. Similar results were observed among men and women. In line with previous research, differential exposure to physical work-related stressors explained most of the occupational class gradient in physical ill health, yet certain psychosocial work-related stressors were also influential. Future research should further examine what other work-related factors – or social determinants of health – can help explain the association between occupational class and mental health.