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Stress due to health information systems among Finnish and migrant physicians and nurses

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Tarja Heponiemen (THL) esitys Work2017-konferenssissa Turussa elokuussa 2017.

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Stress due to health information systems among Finnish and migrant physicians and nurses

  1. 1. 23.8.2017 Stress due to health information systems among Finnish and migrant physicians and nurses Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa
  2. 2. 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 2 • Competent workforce for the future (COPE) – Subproject 3: Optimized utilization of knowledge and skills in culturally diverse health and social care – Funded by Strategic Research Council (number 303604) • Information Systems and Stress in Health Care (Digityö ja stressi-hanke) – Funded by the Finnish Work Environment Fund, project 116104
  3. 3. Changes in the working life and competence needed are in focus 23.8.2017 Competence workforce for the future 3
  4. 4. Stress due to health information systems among Finnish and migrant physicians and nurses • Health care professionals with migration origin may face challenges in adjusting to foreign health care culture. • One particular challenge may be information systems in health care which have been found to burden native physicians (Vänskä et al 2010, Heponiemi 2012). • We examined stress due to information systems in the work of migrant and native physicians and nurses in the Finnish health care and how these differences varied according to working sector and type of employment 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 4
  5. 5. Methods • The data is based on a survey for physicians (natives: n=3646, 55% response rate; migrants: n=549, 43% response rate) and registered nurses (natives: n=1008, 46% response rate; migrants n=515, 45% response rate). • The composite scale for stress experienced due to health information systems (DigiStress) included 2 items: how often had the respondents been distracted, worried, or stressed about a) constantly changing information systems and b) difficult to use, poorly functioning information systems (5-point response scale). • The results were analyzed by ANCOVA adjusted for background factors (Age, gender, working sector, full-time employment, permanent employment and supervisor position for all subgroups and specialization status for physicians; Additional information concerning the migrant respondents was country of origin and year of migrating to Finland) 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 5
  6. 6. Results • Native physicians (F=42.4, p<0.001) and nurses (F=59.4, p<0.001) reported higher DigiStress. 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 6 1 1,5 2 2,5 3 3,5 Physicans Nurses Natives reported higher DigiStress Among physicians (F=42.4 p<.0001) and nurses (F=59.4, p<.0001) native Foreign born
  7. 7. • When migrant respondents’ country of origin was taken into account, Finnish nurses reported more DigiStress compared to nurses from all other countries except Estonia. • Estonian nurses reported higher DigiStress compared to nurses coming from Russia, Asia and Africa (F=56.4, p<0.001). 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 7 1 1,5 2 2,5 3 3,5 Native Finns Estonian Russian Other EU country Other European/ Midle East country Asia Africa North/ South America Native Finns and Estonian nurses reported higher DigiStress than nurses from Russian, Asian or African origin (F=56.4, p<.0001)
  8. 8. • When the length of the stay in Finland among the migrant respondents was included in the analysis, native Finnish nurses reported higher DigiStress than migrant nurses who had moved to Finland after 1990, but not when compared to those who had moved to Finland earlier. • Migrant nurses who had moved to Finland before 1990 reported higher DigiStress than those migrated to Finland after 2000 (F=16. 98, p0.001). Similar pattern of differences appeared among migrant physicians (F=6.6, p<0.001). 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 8 1 1,5 2 2,5 3 3,5 Native Finns before 1990 1990-1999 2000-2005 After 2006 Native nurses and those migrated to Finland before 1990 reported higher DigiStress compared to late arrivals (F=16.98, p<.0001) Foreign born, migrated to Finland ...
  9. 9. 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 9 1 1,5 2 2,5 3 3,5 Native Finns before 1990 1990-1999 2000-2005 After 2006 Native physicians and those migrated to Finland before 1999 reported higher Digi Stress than late arrivials (F=16,6, p<0.0001)
  10. 10. • Among nurses a significant interaction term was found between native/ migrant status and working sector (F=5.5, p<0.001). • The differences between native Finns and migrant nurses in DigiStress were greatest in specialized care, followed by primary and elderly care, while no differences were observed in private sector. 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 10 1 1,5 2 2,5 3 3,5 Specialized care Primary care Private Elderly care Native nurses reported higher DigiStress particularly in specialiced care, no difference in private sector (interaction 5.54, p<.0001) Native Foreign born
  11. 11. • Among physicians significant interaction terms were found between native/ migrant status and having permanent employment (F=6.9, p<0.01) and native/ migrant status and being in supervisor position (F=7.1, p<0.01). • The differences in DigiStress between native and migrant physicians were greater among physicians working on temporal contract and in non-leadership position. 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 11 1 1,5 2 2,5 3 3,5 temporal permanent Native physicians reported higher DigiStress among those with Temporal contract (interaction f=6.9, p<.01) Native Foreign 1 1,5 2 2,5 3 3,5 no superv supervisory Native physicians reported higher Digi stress among those not in suporvisor position (interaction F=7.14, p<.01) Native Foreign
  12. 12. Conclusions • Stress related to information systems in health care is higher among native professionals than their co-workers with migrant origin. Moreover, after having stayed in Finland also migrants’ stress related to information systems starts to increase. • Several potential interpretations for the results may apply. – Digital skills may actually be more advanced among migrant professionals. According to the “healthy migrant” hypothesis postulates that persons who migrate are a selected group in terms of good health status. Migrated nurses and physicians may be a selected group also in terms of psychosocial resources to cope with new situations and technologies. – Migrant respondents may use different assessment criteria in responding to stress-related questions. They may also have different expectations regarding the functioning of information systems based on their experiences in their country of origin. 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 12
  13. 13. Conclusions – It is also possible that in health care units the adjustment of migrant workers is supported by organizing the work so that migrant workers have less responsibility on tasks that may be difficult for them, such as dealing with complex information systems. This interpretation is supported by the fact that native Finns reported more stress due to information systems compared to new arrivals but not when compared to those migrant professionals who have been in Finland longer. This could indicate successful integration processes in health care organization. However, a possible counter effect could be the burden among native professionals (Aalto et all 2014). 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 13
  14. 14. • Twitter: @stncope • @TarjaHeponiemi • http://www.slideshare.net/ta g/cope-hanke • http://videonet.fi/web/thl/201 6106/ • www.stncope.fi • www.thl.fi/digityojastressi 23.8.2017 Kaarina Wilskman Thanks

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