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Psychische Fehlbelastungen in der stationären Altenpflege und Möglichkeiten der Prävention
Eine Untersuchung der bayerischen Gewerbeaufsicht

Objective: In 2005/2006 the Bavarian OSH Inspectorate, in cooperation with the Bavarian Health and Food Safety Authority (LGL), conducted a study on the subject of “occupational safety and health in in-home geriatric care.” The focus was on the psychological stress of geriatric care workers and possibilities for its prevention. Methods: A total of 243 homes for the elderly, that is, approx. 11 % of all geriatric care facilities in Bavaria, were visited in the course of this project. The study instruments were not only the screening instrument SPA-S but also a specially developed questionnaire on the level of OSH organization, compliance with OSH regulations, and measures already taken with regard to the psychological stress situation. This was complemented by an employee survey by means of lists of work-related stress and optimization measures for self-classification by geriatric care workers. Following a discussion and inspection of selected areas of care, target agreements on stress optimization were made, and conditions imposed if OSH standards were not met. Results: 75 % of the inspected homes had not included psychological stress in the legally required hazard assessment, or not included it sufficiently. In many homes the high pressure of time — not infrequently intensified by a sickness-induced absence of employees — leads to a high stress situation for geriatric care workers which can only be partly compensated for. A number of homes had already started to adopt promising measures with the aim of improving the psychological stress situation for their employees. Approximately 4500 geriatric care workers from the inspected homes took part in an employee survey on their stress situation and on possibilities for optimization. Geriatric care workers felt most highly stressed by “too little time for the individual resident,” by high pressure of time and extensive documentation work. On average, they considered the most effective contributions to stress optimization to be work organization measures (timely and sufficient information, unambiguous clarification of responsibilities, creation of time buffers) and advanced training offers. In about 70 % of cases, the condition that they include psychological stress in the legally required hazard assessment was imposed on the facilities. Most frequently, the target agreements with the enterprises involved laying down specific responsibilities relating to “psychological stress”; this was followed in second place by seminars on how to deal with aggressive, confused and demented residents. Conclusions: The study makes it clear that the persons responsible for management and operations in in-home geriatric care must be further sensitized to the thematic area of “psychological (di)stress” and supported in their efforts to determine the work-related psychological stress of geriatric care workers and to implement suitable measures for its prevention. After all, the reduction of psychological stress, which is of prime interest for the health and well-being of the employees, equally promotes the goals of the enterprise itself.