Insight into perceived Positive Health of healthcare professionals. What can be done to improve and stabilize the perceived Positive Health?

Insight into perceived Positive Health of healthcare professionals. 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What can be done to improve and stabilize the perceived Positive Health? Sanne Warta, Martine te Hoonte-Veehof, Carlinde Schoonen, Sandra Hogen-Koster This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5373578/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The shortage of healthcare professionals, combined with the aging population, is leading to increasing pressure on healthcare professionals. To ensure that healthcare professionals are able to do their work and ensure good patient care, it is important to focus on their own health. Positive Health is a health-oriented approach and can be used for understanding and enhancing the health and well-being of healthcare professionals. The aim of the study is to gain insight in the perceived health, personal goals and how to improve or stabilise the Positive Health of employees of a large tertiary hospital in the Netherlands. Methods A qualitative study design was employed. Semi-structured interviews were conducted with employees (n = 15) of the Cardiology and Rheumatology department, using the Positive Health tool. The data was analysed using thematic content analysis. Results Employees are satisfied with their health or a specific part of their health, also when there are health complaints as well. There were personal goals in several themes being: lifestyle changes, balance, self-development, meaningfulness and social interaction. What is needed to achieve personal goals varies, also within the themes. To enhance well-being, employers can provide supervisor support, empower control over hours, create a pleasant environment, offer fruit, provide challenging opportunities, and integrate Positive Health principles. Conclusion In general, the interviewed employees experienced good Positive Health despite the presence of complaints. To enhance employee health, both work-related and personal measures were needed. The Positive Health approach was appreciated by employees and can be valuable for employers to gain insight into how to support employee health. This is particularly important given the growing pressure on the healthcare system. Positive Health Healthcare Professionals Sustainable Employability Occupational Health Introduction The aging population, the increasing number of people living with one or more chronic diseases and the rising health care costs put pressure on the health care system (James et al., 2018 ). A shortage of workforce is a prevalent issue at both the European and global levels and is expected to rise in the upcoming years (Drennan & Ross, 2019 ). In the Netherlands, the current deficit of healthcare professionals is approximately 62.000 and this is expected to rise to 170.000 by 2032 (ABF Research, 2024 ). Simultaneously, the turnover rate in the healthcare sector is high. A significant portion of healthcare professionals is either leaving or considering leaving the healthcare sector. The systematic literature review of de Vries et al. ( 2023 ) identified several determinants influencing the intention to leave, divided in six themes: personal characteristics, job demands, employment services, working conditions, work relationships and organizational culture. Job satisfaction, career development and work-life balance were the main determinants identified (de Vries et al., 2023 ) The shortage of workforce does not only increase the pressure on the health care sector but also on the health care professionals themselves. A cross sectional survey study among 12 European countries showed high rates of nurse burnout, job dissatisfaction and intention to leave (Aiken et al., 2012 ). This can have consequences for patient care since a poor well-being of health care professionals is associated with decreased performance and can result in risks for patient safety (Hall et al., 2016 ; Rainbow et al., 2020 ). To provide sufficient patient care, it is important to take care of the health and wellbeing of health care professionals first. The concept of Positive Health can be used for understanding and enhancing the health and well-being of healthcare professionals. In recent years, the perception of health changed toward more health-oriented approaches, acknowledging that health goes beyond the biomedical aspects. The concept of ‘Positive Health’, as introduced by Huber et al. ( 2011 ), is described as 'the ability to adapt and self-manage in the face of social, physical and emotional challenges' (Huber et al., 2011 )A framework was developed based on qualitative and quantitative research among a broad range of stakeholders such as patients, citizens, health care professionals and health insurers. This resulted in a set of health indicators which were categorized in six dimensions: bodily functions, mental well-being, quality of life, participation, daily functioning, and meaningfulness. The dimensions are represented on a health surface resembling a spiderweb, encompassing all dimensions with values ranging from 0 (poor) to 10 (excellent). In the dialogue tool called My Positive Health (MPH), participants fill in a questionnaire resulting in a health surface. The results of the tool are discussed in what is called the alternative dialogue. This tool can give insight in how people experience their own health and personal goals can be determined (Huber et al., 2016 ). Most studies on the health of health care professionals have focused on physical (Suganthirababu et al., 2023 ) or mental health (Woo et al., 2020 ). Several studies have been conducted in the context of the COVID-19 pandemic (Hill et al., 2022 ; Pappa et al., 2020 ; Varghese et al., 2021 ). To our knowledge, there have been no studies that explored the health of health care professionals using the My Positive Health tool. Therefore, the aim of the study is to gain insight in the perceived health, personal goals and how to improve the Positive Health of health care professionals and non-medical hospital staff of a large tertiary hospital. Ensuring that healthcare workers are healthy is crucial for maintaining their job satisfaction and to ensure good quality care for patients. This is especially important during times of significant pressure on the healthcare system and workforce shortages. Methods Study design and study setting A qualitative study was conducted, using semi-structured interviews. The study took place between March 2022 and July 2023, at the rheumatology and cardiology departments of a large tertiary hospital in the Eastern part of the Netherlands. Participants Participants of this study were health care professionals and non-medical staff employed at the rheumatology and cardiology departments of Medisch Spectrum Twente, from now on called employees. Inclusion criterion was proficiency in the Dutch language. No exclusion criteria were used. Data collection Participants of the study were recruited and informed by email. After signing informed consent, demographic characteristics were collected, and participants completed online the MPH tool to gain insight in their perceived health (Huber et al., 2016 ). The MPH tool was developed by the Institute for Positive Health. It consists of 44 questions, which are answered using a 11-point Likert scale (0 = completely disagree; 10 = completely agree). The results are the mean scores for each dimension, displayed in a spiderweb. The results of the tool were discussed during a semi-structured interview which was conducted in MST by a student psychology (first 10 interviews) or one of the two researchers (CS, SW; last 5 interviews). For the interviews, a topic list was used, containing 4 main topics: participants' experience with the MPH tool, the perceived health, their personal goals, and what is needed to achieve those goals. The interviews were in Dutch and lasted 30–45 minutes. The interviews were recorded using a voice recorder. The researchers continued data collection until data saturation was achieved on at least main themes. Due to the personal approach of the MPH, it was considered not achievable to reach complete data saturation. The anonymized research data is stored on a network drive from Medisch Spectrum Twente and is only accessible for the researchers involved. Data analysis The interviews were transcribed, and the transcripts were anonymized. Analysis was conducted through coding, using the qualitative data analysis software ATLAS.ti Version 8 (ATLAS.TI Scientific Software Development GmbH). A thematic approach was used, involving the identification, analysis, structuring, description, and reporting of themes discovered in the gathered data (Braun & Clarke, 2006 ). SK and MV independently coded and discussed the first ten interviews, resulting in a codebook. Subsequently, five additional interviews were conducted and independently coded by CS and SW using the codebook. If necessary, the codebook was complemented. The final codes and codebook were discussed with all researchers and in case of any discrepancies in coding, the researchers discussed it until consensus was reached. The final version of the codebook was used to review all the transcripts (SW). For reporting the research, the SRQR and COREQ guidelines were followed. Ethical considerations The study protocol was approved by the medical-ethical review committee and the board of directors of Medisch Spectrum Twente hospital and written informed consent was obtained from all participants. Results A total of 15 respondents participated in the study, 8 from the rheumatology department and 7 from the cardiology department. The majority of the respondents was female (n = 13). Eight respondents were medical staff, five were non-medical staff and two combined a medical and non-medical job. The respondent characteristics are shown in Table 1 . Table 1 respondent characteristics Respondent number Gender Department Job title 1 Male Rheumatology Medical staff 2 Male Rheumatology Medical staff 3 Female Rheumatology Non-medical staff 4 Female Rheumatology Medical staff 5 Female Rheumatology Medical staff 6 Female Rheumatology Non-medical staff 7 Female Cardiology Medical as well as non-medical staff 8 Female Cardiology Non-medical staff 9 Female Cardiology Non-medical staff 10 Female Cardiology Medical staff 11 Female Rheumatology Medical staff 12 Female Rheumatology Medical staff 13 Female Cardiology Medical staff 14 Female Cardiology Medical as well as non-medical staff 15 Female Cardiology Non-medical staff Experience with the Positive Health dialogue tool Respondents were asked how they experienced using the dialogue tool. Most respondents said that it was easy to fill in and that they liked using the tool. The tool was perceived useful for gaining insight in their health: “It was quite clarifying. More things get attention, not just your physical health. I did not think about the questions too much. I feel like it was quite a nice way to bring attention to a broad range of aspects.” (respondent 3) Some critical notes were that the concepts are very broad and can be interpreted differently by different people and that completion of the tool is a snapshot in time influenced by circumstances, thoughts, and emotions at that time. Perceived health Although many respondents experienced one or more health complaints, almost everyone indicated satisfaction with their health. This could be satisfaction with their overall health: “I am satisfied with the way things are now, it doesn't need to be improved for me now” (respondent 1), or satisfaction with parts of their health: “There is not much to improve except for the bodily functions. I contribute something to society, and I enjoy my work. There is nothing to improve, I am satisfied. I feel like my work is meaningful.” (respondent 8) Moreover, several respondents said that they do not strive for perfection: “I don’t strive for nines … And why do I say that, there are always areas for improvement. A ten means you have a perfect life and that is not possible.” ( respondent 9) Two-thirds of the respondents experienced one or more health complaints. These were mainly physical complaints. Several respondents reported musculoskeletal complaints including complaints about the knee, back, leg, shoulder and muscles. Respondent 5: "I just can't put enough pressure on my knee without experiencing pain." Some respondents had sleep complaints, all with a different cause for their problems. Furthermore, some respondents reported long COVID complaints, including fatigue, a reduced condition, palpitations, and shortness of breath. A nurse talked about these complaints (respondent 7): “I have long COVID. It means I get tired more easily and experience symptoms like heart palpitations, shortness of breath, lack of fitness, and poor condition. One day I have energy, the next day I don't." Besides, there were complaints categorised as ‘other’, being Lipoedema, fatigue and needing more recovery time. About a quarter of the respondents experienced mental health complaints. These complaints were mainly related to work, except for memory complaints due to sleep apnoea. One respondent felt insecure about collaborating at work and being assessed frequently. Other respondents encountered a heavy workload due to busyness at work. For one respondent, this resulted in an inability to complete all tasks, while for the other, it led to a lack of energy for activities in their private life. One of these respondents also struggled to maintain a good work-life balance, because she frequently thought about work at home and occasionally engaged in work during her free time, facilitated by the ability to work from home. This respondent said: ‘In general, I find mental well-being at work a bit more difficult, because you experience more pressure. It is more demanding and in private you can think and talk about it a bit more, you have time to discuss things back and forward. And here (at work), at times, you still must push through amidst the busyness of the day or the stress surrounding it. Things that are expected of you. It's more that it makes me a bit restless, and I also carry that back home. Those are things that preoccupy me at home as well.’ (respondent 3) Personal goals Most respondents did have personal goals regarding their Positive Health. Personal goals were identified in all dimensions, with bodily functions being the most common. The personal goals varied among the respondents and only a few had similar goals. Personal goals were identified among respondents who were satisfied with their health as well as those who experienced health complaints. Although statements have been made about separate dimensions, it became apparent that goals often span multiple dimensions. Consequently, the decision was made to move away from the individual dimensions and instead examine themes within the desired changes. Themes that emerged as personal goals were lifestyle changes, balance, self-development, meaningfulness and social interaction. The themes, corresponding goals and what is needed to achieve the goals are shown in Table 2 . Table 2 personal goals of the respondents Theme Goals What is needed? Lifestyle changes (n = 6) To do sports more often Support of a professional Reduction of back complaints Physical activities Support of a professional Make changes in the eating pattern - Sleep better Medical device To reduce covid complaints Ergonomic adjustments More staff Flexibility at work Support of (in)direct colleagues To lose weight Physical activities Eating more healthy Support of a professional To become stronger Physical activities Support of a professional Balance (n = 3) Have more balance, more time for yourself and more time for relaxation. Setting boundaries Planning Setting priorities Better work-life balance (More) time at work Other work / tasks Ergonomic adjustments Support of (in)direct colleagues Planning Keeping work and private life separate To be able to set boundaries better (More) time in general Setting priorities Have a better work private balance (More) time in general Setting priorities Meaningfullness (n = 2) Have more challenging work Other work / tasks Support of (in)direct colleagues Have a more meaningful life, to think about what you can do for yourself and others and become more empowered - Do something meaningful for the society such as volunteer work (More) time in general Volunteer work Self-development (n = 2) Accepting your own characteristics Support of (in)direct colleagues Being able to better concentrate and shape life more independently Keeping work and private life separate Planning Setting boundaries Support of a professional Medical device Improving in collaborating with colleagues Personal development Support of (in)direct colleagues Social interactions (n = 1) Getting to know more people in work as well as private life Support of (in)direct colleagues About a quarter of the respondents were willing to make lifestyle changes regarding moving, exercising, eating and/or sleeping. For instance, respondent 11 expressed: “I would like to become stronger again and lose weight. I had to sit still the whole time, then you gain weight no matter what you do. So I want to tackle that again, which I am already doing.” Several respondents wanted to gain more balance in their life, such as work-life balance or more time for relaxation. Respondent 15 elaborated on this: “What I often do now, is that I first do a lot of things for the other person and then I also want to do something for myself, but I actually don't have enough time for that. So in that sense I would like to have a little more balance. That I can also relax a little more. Cycling, walking, things that I like and I want to give more priority to that. And that is already going better.” Furthermore, a number of respondents expressed a desire to work on creating a more meaningful life. Respondent 6 stated: “I would like to have a little more time to do more volunteer work, to support older people.” Additionally, a few respondents had a personal goal regarding self-development. These goals varied from enhancing concentration, accepting oneself, improving collaboration with others, and to become more independent. One respondent had a goal in the theme social interactions, which was getting to know more people in work as well as private live. What is needed to work on personal goals? Some respondents were already working on their personal goals, while others were planning to work on their goals. What is needed to work on personal goals varied among respondents, even within the identified themes. In general, a distinction could be made between work-related measures and personal measures. Work-related measures The work-related measures that emerged were receiving support from colleagues or superiors, doing other work / tasks, making ergonomic adjustments, having (more) time at work to work on tasks, increasing staff and enhancing flexibility on work. Support from colleague’s and managers in the workplace is an important factor for achieving personal goals. This involves working together, receiving feedback, spending time together in an informal way and discussing your work with the manager. Also taking care of each other and managing workload collectively was mentioned: “ My colleagues are afraid that I will collapse one day, so they always say: ‘no, you shouldn’t do that!’ Or they ensure that the agenda is not very full.” (respondent 15). A few respondents expressed a desire to make changes in their current work situation, either by looking for another job or reorganising their existing tasks to work more effectively. One respondent emphasized the importance of gaining more knowledge and experience to improve confidence in his work and facilitate collaboration with colleagues. There were several things that the employer can do to contribute to the personal goals of its employees. A few respondents indicated that they need adjustments in the workplace, such as having a quiet place to work, having fresh air in the workspace and having ergonomic office furniture. Others mentioned the need for more time for tasks at work, additional staff and greater flexibility in planning the workday. Regarding the latter, respondent 7 mentioned: “I notice that if I have rest and do not have to get out of bed very early in the morning and can organize my day myself, I have fewer complaints. … That I can decide for myself what my day will look like. If I feel worse, I keep it a bit calmer. But I don’t know how the hospital could solve that for me. I would have to partially go on sick leave, but I don’t want that.” Some (additional) measures were mentioned that, while unrelated to personal goals, were considered important in promoting the overall well-being of staff or ensuring job satisfaction. Respondents emphasized the significance of having a supportive and approachable supervisor, expressing the belief that this is equally essential for all colleagues within MST. Additionally, some respondents valued having control over their working hours, for one respondent this means having regular working hours, for another respondent this was great flexibility in planning their time and work. For another respondent this involved the option of remote work. Other points highlighted by a few respondents included sufficient challenge in their work, recognition and encouragement of the qualities of employees, and a more integrated approach of Positive Health. Providing a pleasant work environment with enough privacy, ergonomic office furniture and offering company fruit were also mentioned as desirable measures. Personal measures The personal measures that emerged include lifestyle changes (including physical activities and eating healthier), support of a professional, creating more balance (including setting boundaries, planning, setting priorities and keeping work and private life separate), (more) time in general, volunteer work, personal development and using a medical device including a sleep apnoea device. One-fifth of the respondents began making lifestyle changes related to goals in the bodily functions dimension. These changes involved engaging in physical activities, such as doing sports and changing eating habits. Several respondents were already consulting one or more healthcare professionals to work on their goals, including physiotherapists, an osteopath, a trainer in the gym, and participating in a lifestyle program. One-fifth of the respondents noted that they needed to create more balance. This could be achieved in several ways, such as setting boundaries, prioritizing, planning, and creating more spare time. Respondent 3 explained: “Previously you said I won't come or I plan it on a working day. But now you can also join online on your days off. I am now trying to define it more and choose whether I will do it or not. And to let go at the weekend. That gives you more peace, a bit of work-life balance.” Another respondent (15) told: “I need to be more aware of, it might sound strange, but actually: I put the patient on the second place. First, I need to take care of myself and then I can take care of the other.” A few individual respondents expressed a need for other things, such as more time, doing volunteer work, and accepting yourself. One respondent expressed: “I would like to have more time to do more volunteer work, to support elderly people.” (respondent 6) One respondent needed a medical device to improve sleep quality. Discussion In this study, we investigated the perceived health, personal goals and ways to promote or stabilise the Positive Health of health care professionals and non-medical hospital staff of the rheumatology and cardiology department of a large tertiary hospital. The study revealed that employees are generally satisfied with their health or specific aspects of it, even in the presence of health complaints. The health complaints found were mainly physical complaints, with musculoskeletal complains being the most common. This is in line with other studies. A systematic literature review regarding the prevalence of work-related musculoskeletal disorders among health care professionals showed that health care professionals are more prone to develop musculoskeletal disorders (Suganthirababu et al., 2023 ). Also, long covid complaints were experienced by employees. Long covid complaints among healthcare workers is reported in several other studies. (Izadi et al., 2023 ; Peters et al., 2022 )Next to physical complaints, mental health complaints were identified, such as a high workload and challenges in maintaining a good work-life balance. A review on burnout symptoms in nurses revealed a high prevalence of burnout symptoms that requires attention (Woo et al., 2020 ). Therefore, it is crucial to address the mental health complaints of employees as identified in the study, in order to prevent burn-out. The personal goals of employees vary. Themes that emerged in the data include lifestyle, balance, meaningfulness, personal development, and social interactions. These goals are not always directly related to the health complaints that employees experience. Also, employees who are (partly) satisfied with their health have goals. To our knowledge, there are no other studies that have examined the personal goals of employees in hospitals concerning their health. What was needed to work on the personal goals also varies. Work-related measures were receiving support from colleagues or superiors, doing other work / tasks, making ergonomic adjustments, having (more) time at work to work on tasks, increasing staff and enhancing flexibility on work. To enhance the overall health and well-being of employees, irrespective of their personal goals, employers can ensure sufficient supervisor support, empower employees to control their working hours, provide a pleasant work environment, offer company fruit, present challenging work opportunities, and integrate Positive Health within the hospital. Personal measures needed to pursue a personal goal include lifestyle changes, support of a professional, creating more balance, (more) time in general, volunteer work, personal development and using a medical device. Some of these measures were also found in other studies. One study on well-being of nurses at work found that interaction with colleagues is important for nurses’ well-being (Utriainen et al., 2009 ). Another study on the mental health and well-being of mental health nurses in the UK revealed that the subjective well-being of nurses was relatively low (Oates, 2018 ). Some nurses employed strategies to enhance their well-being, both within and outside the workplace. Consistent with our study, well-being was associated with delineating clear boundaries between home and work life, participating in regular clinical supervision at the workplace, and incorporating physical exercise. Applying lessons learned from working with patients to their own lives, mindfulness practices, spending time in nature, and listening to music were not found in our study. The study underscored the importance of adopting a personalized approach, a point also highlighted in our research (Oates, 2018 ). Furthermore, it is noteworthy that individuals with a goal in the bodily functions dimension more often have already started working on their goal compared to those with goals in other dimensions. It is possible that initiating efforts in the bodily function dimension may be easier than in other dimensions, potentially due to a greater availability of opportunities within healthcare and the social domain to address physical health. Strengths and limitations A strength of the study is the use of triangulation, with multiple researchers involved in coding the interviews to enhance the reliability of the coding. Also, we included a diverse range of job function groups. A weakness of the study is that the study population mainly consists of women, so it's possible that the results may not be representative of all employees. On the other hand, the proportion of women in the study departments is also significantly higher. Due to the inclusion of two departments in the study, the findings may not be directly generalizable to the entire hospital. Another weakness is that it was not clear to all respondents what is needed to work on their personal goals. Employees did not always have an immediate answer and sometimes needed additional time for reflection. Implications for practice This study emphasizes the need for a personal approach in promoting the health of employees, due to varying goals and needs. Employees value the Positive Health perspective in addressing their health and well-being. A next step could be to implement the MPH tool in the workplace, for instance by incorporating this in the annual review. To start with, the employee fills in the MPH tool. Subsequently, the alternative dialogue can take place with the supervisor or another person the employee trusts, such as a confidential advisor. Together they discuss what is important, determine if there are any personal goals and what measures are needed to pursue these goals. It can also be used in a team setting, where a team will use the Positive Health spider web to explore what contribute to the ability to work in a health and enjoyable way. When implementing Positive Health at the workplace several things are important, as described in the Dutch report on Positive Health in the workplace(Institute for Positive Health, 2019 ). For example, it is important to continuously pay attention to the Positive Health of employees, and not just at one moment. Employees indicate that filling out the MPH tool is a snapshot and that it may change over time. Therefore, it is crucial for employers to engage in ongoing conversations with employees. Besides, it is important as an employer to be able to offer a broad range of interventions to improve or stabilise the health of employees, since the needs vary. Implications for further research For further research, it is interesting to quantitatively assess whether the results found in this study apply to more employees. Besides, studying the effects of applying the Positive Health framework in a workplace setting would be intriguing. It is interesting to examine whether the use of the MPH tool by employees leads to actions by the employee and/or employer and what impact this has on the health and job satisfaction of the employee. Conclusion In general, the interviewed employees experienced good Positive Health, despite the presence of complaints. Various personal goals were identified, and several measures, both work-related and personal, were needed to pursue these goals. The variation in goals and needs emphasizes the importance of a personalized approach to promote employee health. The approach of Positive Health was appreciated by employees. The alternative dialogue could be a good way to initiate a conversation with employees about their perceived health in a broad sense, and action can be taken if applicable. It can be valuable for sustainable employability, providing insight into how employers can support the health of employees. Supporting employee health is crucial for job satisfaction, delivering quality care, and retaining healthcare workers. This is especially important now, as the pressure on healthcare and its employees continues to grow due to aging populations and workforce shortages. Abbreviations MPH: My Positive Health Declarations Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The research is part of the L.INT lectorate Positive Health which is partly funded from the taskforce for Applied Research SIA. Competing interests The authors have no relevant financial or non-financial interests to disclose. Acknowledgements We would like to thank Dilara Metin for the support in data collection. We would like to thank all employees that participated in the study. Authors’ contributions SW conducted, transcribed and analysed interviews and was responsible for acquisition of subjects, interpretation of the results and writing of this manuscript. SK and MV were responsible for the coordination of the study, the design of the study, reviewing the data analysis, interpretation of the results and reviewing this manuscript. CS conducted, transcribed and analysed interviews and was responsible for acquisition of subjects and interpretation of the results. All authors read and approved the final manuscript. Ethical approval and consent to participate The study protocol was approved by the medical-ethical review committee and the board of directors of Medisch Spectrum Twente hospital (K22-25). Consent to participate Written informed consent was obtained from all participants. All participants consented to the use of anonymized quotes in research publications. References ABF Research. (2024). Prognosemodel zorg en welzijn . www.abfresearch.nl. 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Rainbow JG, Drake DA, Steege LM. Nurse Health, Work Environment, Presenteeism and Patient Safety. West J Nurs Res. 2020;42(5):332–9. https://doi.org/10.1177/0193945919863409 . Suganthirababu P, Parveen A, Mohan Krishna P, Sivaram B, Kumaresan A, Srinivasan V, Vishnuram S, Alagesan J, Prathap L. Prevalence of work-related musculoskeletal disorders among health care professionals: A systematic review. Work. 2023;74(2):455–67. https://doi.org/10.3233/WOR-211041 . Utriainen K, Kyngäs H, Nikkilä J. Well-being at work among ageing hospital nurses in Northern Finland: a grounded theory study. Int J Circumpolar Health. 2009;68(2):145–57. https://doi.org/10.3402/ijch.v68i2.18325 . Varghese A, George G, Kondaguli SV, Naser AY, Khakha DC, Chatterji R. Decline in the mental health of nurses across the globe during COVID-19: A systematic review and meta-analysis. J Global Health. 2021;11:05009. https://doi.org/10.7189/jogh.11.05009 . Woo T, Ho R, Tang A, Tam W. Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis. J Psychiatr Res. 2020;123:9–20. https://doi.org/10.1016/j.jpsychires.2019.12.015 . Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial1.docx Supplementary information An overview of the codes is provided in a code list in ‘Supplementary Material 1’. The following supplements are available in Dutch upon request from the corresponding author: Research protocol and the topic list used for semi-structured interviews. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5373578","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":383517579,"identity":"85af72a1-e180-4461-a541-df027abedb22","order_by":0,"name":"Sanne Warta","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYJADxgdAgoePeA1sDMwGIC1spGhhk4DQBIB8+9ljDz4wHJY3n9/8rPJrjp0M0LaHj27g0WJwJi/dcAbDYcM5x9jMbstuSwY6jM3YOAefFoYcM2kehtuMM9gYzG5LbmMGauFhk8anRb7/jZn0H4bb9jPY2L8VS26rJ6yF4QbQFgaG24kz2HjMGD9uO0xYi8GNN2aSPQb/k2ew5RRLM247zsPGTMAv8v05ZhI/KtJsZzAf3/jx57Zqe3725oeP8ToMYheEYuYBkwSVIwHGH6SoHgWjYBSMghEDAIsPPrrHp2iZAAAAAElFTkSuQmCC","orcid":"","institution":"Medisch Spectrum Twente","correspondingAuthor":true,"prefix":"","firstName":"Sanne","middleName":"","lastName":"Warta","suffix":""},{"id":383517580,"identity":"6a8e9565-6ed5-4dd2-adfb-6e9b88dae34a","order_by":1,"name":"Martine te Hoonte-Veehof","email":"","orcid":"","institution":"Medisch Spectrum Twente","correspondingAuthor":false,"prefix":"","firstName":"Martine","middleName":"te","lastName":"Hoonte-Veehof","suffix":""},{"id":383517581,"identity":"b77dbf18-9270-4055-94b9-b5ed44b1f16f","order_by":2,"name":"Carlinde Schoonen","email":"","orcid":"","institution":"Medisch Spectrum Twente","correspondingAuthor":false,"prefix":"","firstName":"Carlinde","middleName":"","lastName":"Schoonen","suffix":""},{"id":383517582,"identity":"a4901829-8c7e-495f-a77e-42847e5a07f3","order_by":3,"name":"Sandra Hogen-Koster","email":"","orcid":"","institution":"Saxion University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sandra","middleName":"","lastName":"Hogen-Koster","suffix":""}],"badges":[],"createdAt":"2024-11-01 13:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5373578/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5373578/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71654084,"identity":"9d95a731-5a5e-4e65-aebc-f029e824074c","added_by":"auto","created_at":"2024-12-17 12:39:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":526789,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5373578/v1/5c3428ab-9f3c-4184-b58a-953a8f09bcdd.pdf"},{"id":70106187,"identity":"14590f46-be1e-48de-829a-3cc25e09c9bf","added_by":"auto","created_at":"2024-11-28 11:33:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17418,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn overview of the codes is provided in a code list in ‘Supplementary Material 1’.\u003c/p\u003e\n\u003cp\u003eThe following supplements are available in Dutch upon request from the corresponding author: Research protocol and the topic list used for semi-structured interviews.\u003c/p\u003e","description":"","filename":"Supplementarymaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5373578/v1/9e2971b1707a35684cadf229.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Insight into perceived Positive Health of healthcare professionals. What can be done to improve and stabilize the perceived Positive Health?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe aging population, the increasing number of people living with one or more chronic diseases and the rising health care costs put pressure on the health care system (James et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). A shortage of workforce is a prevalent issue at both the European and global levels and is expected to rise in the upcoming years (Drennan \u0026amp; Ross, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In the Netherlands, the current deficit of healthcare professionals is approximately 62.000 and this is expected to rise to 170.000 by 2032 (ABF Research, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Simultaneously, the turnover rate in the healthcare sector is high. A significant portion of healthcare professionals is either leaving or considering leaving the healthcare sector. The systematic literature review of de Vries et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) identified several determinants influencing the intention to leave, divided in six themes: personal characteristics, job demands, employment services, working conditions, work relationships and organizational culture. Job satisfaction, career development and work-life balance were the main determinants identified (de Vries et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe shortage of workforce does not only increase the pressure on the health care sector but also on the health care professionals themselves. A cross sectional survey study among 12 European countries showed high rates of nurse burnout, job dissatisfaction and intention to leave (Aiken et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). This can have consequences for patient care since a poor well-being of health care professionals is associated with decreased performance and can result in risks for patient safety (Hall et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Rainbow et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo provide sufficient patient care, it is important to take care of the health and wellbeing of health care professionals first. The concept of Positive Health can be used for understanding and enhancing the health and well-being of healthcare professionals. In recent years, the perception of health changed toward more health-oriented approaches, acknowledging that health goes beyond the biomedical aspects. The concept of \u0026lsquo;Positive Health\u0026rsquo;, as introduced by Huber et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), is described as 'the ability to adapt and self-manage in the face of social, physical and emotional challenges' (Huber et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)A framework was developed based on qualitative and quantitative research among a broad range of stakeholders such as patients, citizens, health care professionals and health insurers. This resulted in a set of health indicators which were categorized in six dimensions: bodily functions, mental well-being, quality of life, participation, daily functioning, and meaningfulness. The dimensions are represented on a health surface resembling a spiderweb, encompassing all dimensions with values ranging from 0 (poor) to 10 (excellent). In the dialogue tool called My Positive Health (MPH), participants fill in a questionnaire resulting in a health surface. The results of the tool are discussed in what is called the alternative dialogue. This tool can give insight in how people experience their own health and personal goals can be determined (Huber et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost studies on the health of health care professionals have focused on physical (Suganthirababu et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) or mental health (Woo et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Several studies have been conducted in the context of the COVID-19 pandemic (Hill et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Pappa et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Varghese et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). To our knowledge, there have been no studies that explored the health of health care professionals using the My Positive Health tool. Therefore, the aim of the study is to gain insight in the perceived health, personal goals and how to improve the Positive Health of health care professionals and non-medical hospital staff of a large tertiary hospital. Ensuring that healthcare workers are healthy is crucial for maintaining their job satisfaction and to ensure good quality care for patients. This is especially important during times of significant pressure on the healthcare system and workforce shortages.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and study setting\u003c/h2\u003e \u003cp\u003eA qualitative study was conducted, using semi-structured interviews. The study took place between March 2022 and July 2023, at the rheumatology and cardiology departments of a large tertiary hospital in the Eastern part of the Netherlands.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eParticipants of this study were health care professionals and non-medical staff employed at the rheumatology and cardiology departments of Medisch Spectrum Twente, from now on called employees. Inclusion criterion was proficiency in the Dutch language. No exclusion criteria were used.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eParticipants of the study were recruited and informed by email. After signing informed consent, demographic characteristics were collected, and participants completed online the MPH tool to gain insight in their perceived health (Huber et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The MPH tool was developed by the Institute for Positive Health. It consists of 44 questions, which are answered using a 11-point Likert scale (0\u0026thinsp;=\u0026thinsp;completely disagree; 10\u0026thinsp;=\u0026thinsp;completely agree). The results are the mean scores for each dimension, displayed in a spiderweb.\u003c/p\u003e \u003cp\u003eThe results of the tool were discussed during a semi-structured interview which was conducted in MST by a student psychology (first 10 interviews) or one of the two researchers (CS, SW; last 5 interviews).\u003c/p\u003e \u003cp\u003eFor the interviews, a topic list was used, containing 4 main topics: participants' experience with the MPH tool, the perceived health, their personal goals, and what is needed to achieve those goals. The interviews were in Dutch and lasted 30\u0026ndash;45 minutes. The interviews were recorded using a voice recorder.\u003c/p\u003e \u003cp\u003eThe researchers continued data collection until data saturation was achieved on at least main themes. Due to the personal approach of the MPH, it was considered not achievable to reach complete data saturation. The anonymized research data is stored on a network drive from Medisch Spectrum Twente and is only accessible for the researchers involved.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe interviews were transcribed, and the transcripts were anonymized. Analysis was conducted through coding, using the qualitative data analysis software ATLAS.ti Version 8 (ATLAS.TI Scientific Software Development GmbH). A thematic approach was used, involving the identification, analysis, structuring, description, and reporting of themes discovered in the gathered data (Braun \u0026amp; Clarke, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSK and MV independently coded and discussed the first ten interviews, resulting in a codebook. Subsequently, five additional interviews were conducted and independently coded by CS and SW using the codebook. If necessary, the codebook was complemented. The final codes and codebook were discussed with all researchers and in case of any discrepancies in coding, the researchers discussed it until consensus was reached. The final version of the codebook was used to review all the transcripts (SW). For reporting the research, the SRQR and COREQ guidelines were followed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e The study protocol was approved by the medical-ethical review committee and the board of directors of Medisch Spectrum Twente hospital and written informed consent was obtained from all participants.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 15 respondents participated in the study, 8 from the rheumatology department and 7 from the cardiology department. The majority of the respondents was female (n\u0026thinsp;=\u0026thinsp;13). Eight respondents were medical staff, five were non-medical staff and two combined a medical and non-medical job. The respondent characteristics are shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003erespondent characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespondent\u003c/p\u003e \u003cp\u003enumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDepartment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJob title\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-medical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-medical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCardiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical as well as non-medical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCardiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-medical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCardiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-medical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCardiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCardiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCardiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical as well as non-medical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCardiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-medical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eExperience with the Positive Health dialogue tool\u003c/h3\u003e\n\u003cp\u003eRespondents were asked how they experienced using the dialogue tool. Most respondents said that it was easy to fill in and that they liked using the tool. The tool was perceived useful for gaining insight in their health: \u003cem\u003e\u0026ldquo;It was quite clarifying. More things get attention, not just your physical health. I did not think about the questions too much. I feel like it was quite a nice way to bring attention to a broad range of aspects.\u0026rdquo;\u003c/em\u003e (respondent 3) Some critical notes were that the concepts are very broad and can be interpreted differently by different people and that completion of the tool is a snapshot in time influenced by circumstances, thoughts, and emotions at that time.\u003c/p\u003e\n\u003ch3\u003ePerceived health\u003c/h3\u003e\n\u003cp\u003eAlthough many respondents experienced one or more health complaints, almost everyone indicated satisfaction with their health. This could be satisfaction with their overall health: \u003cem\u003e\u0026ldquo;I am satisfied with the way things are now, it doesn't need to be improved for me now\u0026rdquo;\u003c/em\u003e (respondent 1), or satisfaction with parts of their health: \u003cem\u003e\u0026ldquo;There is not much to improve except for the bodily functions. I contribute something to society, and I enjoy my work. There is nothing to improve, I am satisfied. I feel like my work is meaningful.\u0026rdquo;\u003c/em\u003e (respondent 8) Moreover, several respondents said that they do not strive for perfection: \u003cem\u003e\u0026ldquo;I don\u0026rsquo;t strive for nines \u0026hellip; And why do I say that, there are always areas for improvement. A ten means you have a perfect life and that is not possible.\u0026rdquo; (\u003c/em\u003erespondent 9)\u003c/p\u003e \u003cp\u003eTwo-thirds of the respondents experienced one or more health complaints. These were mainly physical complaints. Several respondents reported musculoskeletal complaints including complaints about the knee, back, leg, shoulder and muscles. Respondent 5: \u003cem\u003e\"I just can't put enough pressure on my knee without experiencing pain.\"\u003c/em\u003e Some respondents had sleep complaints, all with a different cause for their problems. Furthermore, some respondents reported long COVID complaints, including fatigue, a reduced condition, palpitations, and shortness of breath. A nurse talked about these complaints (respondent 7): \u003cem\u003e\u0026ldquo;I have long COVID. It means I get tired more easily and experience symptoms like heart palpitations, shortness of breath, lack of fitness, and poor condition. One day I have energy, the next day I don't.\"\u003c/em\u003e Besides, there were complaints categorised as \u0026lsquo;other\u0026rsquo;, being Lipoedema, fatigue and needing more recovery time.\u003c/p\u003e \u003cp\u003eAbout a quarter of the respondents experienced mental health complaints. These complaints were mainly related to work, except for memory complaints due to sleep apnoea. One respondent felt insecure about collaborating at work and being assessed frequently. Other respondents encountered a heavy workload due to busyness at work. For one respondent, this resulted in an inability to complete all tasks, while for the other, it led to a lack of energy for activities in their private life. One of these respondents also struggled to maintain a good work-life balance, because she frequently thought about work at home and occasionally engaged in work during her free time, facilitated by the ability to work from home. This respondent said: \u003cem\u003e\u0026lsquo;In general, I find mental well-being at work a bit more difficult, because you experience more pressure. It is more demanding and in private you can think and talk about it a bit more, you have time to discuss things back and forward. And here (at work), at times, you still must push through amidst the busyness of the day or the stress surrounding it. Things that are expected of you. It's more that it makes me a bit restless, and I also carry that back home. Those are things that preoccupy me at home as well.\u0026rsquo;\u003c/em\u003e (respondent 3)\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePersonal goals\u003c/h2\u003e \u003cp\u003eMost respondents did have personal goals regarding their Positive Health. Personal goals were identified in all dimensions, with bodily functions being the most common. The personal goals varied among the respondents and only a few had similar goals. Personal goals were identified among respondents who were satisfied with their health as well as those who experienced health complaints.\u003c/p\u003e \u003cp\u003eAlthough statements have been made about separate dimensions, it became apparent that goals often span multiple dimensions. Consequently, the decision was made to move away from the individual dimensions and instead examine themes within the desired changes. Themes that emerged as personal goals were lifestyle changes, balance, self-development, meaningfulness and social interaction. The themes, corresponding goals and what is needed to achieve the goals are shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epersonal goals of the respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGoals\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhat is needed?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eLifestyle changes (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo do sports more often\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupport of a professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduction of back complaints\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical activities\u003c/p\u003e \u003cp\u003eSupport of a professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMake changes in the eating pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSleep better\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedical device\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo reduce covid complaints\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eErgonomic adjustments\u003c/p\u003e \u003cp\u003eMore staff\u003c/p\u003e \u003cp\u003eFlexibility at work\u003c/p\u003e \u003cp\u003eSupport of (in)direct colleagues\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo lose weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical activities\u003c/p\u003e \u003cp\u003eEating more healthy\u003c/p\u003e \u003cp\u003eSupport of a professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo become stronger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical activities\u003c/p\u003e \u003cp\u003eSupport of a professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBalance (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave more balance, more time for yourself and more time for relaxation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSetting boundaries\u003c/p\u003e \u003cp\u003ePlanning\u003c/p\u003e \u003cp\u003eSetting priorities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBetter work-life balance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(More) time at work\u003c/p\u003e \u003cp\u003eOther work / tasks\u003c/p\u003e \u003cp\u003eErgonomic adjustments\u003c/p\u003e \u003cp\u003eSupport of (in)direct colleagues Planning\u003c/p\u003e \u003cp\u003eKeeping work and private life separate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo be able to set boundaries better\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(More) time in general\u003c/p\u003e \u003cp\u003eSetting priorities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave a better work private balance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(More) time in general\u003c/p\u003e \u003cp\u003eSetting priorities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMeaningfullness (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave more challenging work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther work / tasks\u003c/p\u003e \u003cp\u003eSupport of (in)direct colleagues\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave a more meaningful life, to think about what you can do for yourself and others and become more empowered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo something meaningful for the society such as volunteer work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(More) time in general\u003c/p\u003e \u003cp\u003eVolunteer work\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSelf-development (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccepting your own characteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupport of (in)direct colleagues\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeing able to better concentrate and shape life more independently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKeeping work and private life separate\u003c/p\u003e \u003cp\u003ePlanning\u003c/p\u003e \u003cp\u003eSetting boundaries\u003c/p\u003e \u003cp\u003eSupport of a professional\u003c/p\u003e \u003cp\u003eMedical device\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImproving in collaborating with colleagues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePersonal development\u003c/p\u003e \u003cp\u003eSupport of (in)direct colleagues\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial interactions (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGetting to know more people in work as well as private life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupport of (in)direct colleagues\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAbout a quarter of the respondents were willing to make lifestyle changes regarding moving, exercising, eating and/or sleeping. For instance, respondent 11 expressed: \u003cem\u003e\u0026ldquo;I would like to become stronger again and lose weight. I had to sit still the whole time, then you gain weight no matter what you do. So I want to tackle that again, which I am already doing.\u0026rdquo;\u003c/em\u003e Several respondents wanted to gain more balance in their life, such as work-life balance or more time for relaxation. Respondent 15 elaborated on this: \u003cem\u003e\u0026ldquo;What I often do now, is that I first do a lot of things for the other person and then I also want to do something for myself, but I actually don't have enough time for that. So in that sense I would like to have a little more balance. That I can also relax a little more. Cycling, walking, things that I like and I want to give more priority to that. And that is already going better.\u0026rdquo;\u003c/em\u003e Furthermore, a number of respondents expressed a desire to work on creating a more meaningful life. Respondent 6 stated: \u003cem\u003e\u0026ldquo;I would like to have a little more time to do more volunteer work, to support older people.\u0026rdquo;\u003c/em\u003e Additionally, a few respondents had a personal goal regarding self-development. These goals varied from enhancing concentration, accepting oneself, improving collaboration with others, and to become more independent. One respondent had a goal in the theme social interactions, which was getting to know more people in work as well as private live.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eWhat is needed to work on personal goals?\u003c/h2\u003e \u003cp\u003eSome respondents were already working on their personal goals, while others were planning to work on their goals. What is needed to work on personal goals varied among respondents, even within the identified themes. In general, a distinction could be made between work-related measures and personal measures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eWork-related measures\u003c/h2\u003e \u003cp\u003eThe work-related measures that emerged were receiving support from colleagues or superiors, doing other work / tasks, making ergonomic adjustments, having (more) time at work to work on tasks, increasing staff and enhancing flexibility on work.\u003c/p\u003e \u003cp\u003eSupport from colleague\u0026rsquo;s and managers in the workplace is an important factor for achieving personal goals. This involves working together, receiving feedback, spending time together in an informal way and discussing your work with the manager. Also taking care of each other and managing workload collectively was mentioned: \u0026ldquo;\u003cem\u003eMy colleagues are afraid that I will collapse one day, so they always say: \u0026lsquo;no, you shouldn\u0026rsquo;t do that!\u0026rsquo; Or they ensure that the agenda is not very full.\u0026rdquo;\u003c/em\u003e (respondent 15). A few respondents expressed a desire to make changes in their current work situation, either by looking for another job or reorganising their existing tasks to work more effectively. One respondent emphasized the importance of gaining more knowledge and experience to improve confidence in his work and facilitate collaboration with colleagues. There were several things that the employer can do to contribute to the personal goals of its employees. A few respondents indicated that they need adjustments in the workplace, such as having a quiet place to work, having fresh air in the workspace and having ergonomic office furniture. Others mentioned the need for more time for tasks at work, additional staff and greater flexibility in planning the workday. Regarding the latter, respondent 7 mentioned: \u003cem\u003e\u0026ldquo;I notice that if I have rest and do not have to get out of bed very early in the morning and can organize my day myself, I have fewer complaints. \u0026hellip; That I can decide for myself what my day will look like. If I feel worse, I keep it a bit calmer. But I don\u0026rsquo;t know how the hospital could solve that for me. I would have to partially go on sick leave, but I don\u0026rsquo;t want that.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eSome (additional) measures were mentioned that, while unrelated to personal goals, were considered important in promoting the overall well-being of staff or ensuring job satisfaction. Respondents emphasized the significance of having a supportive and approachable supervisor, expressing the belief that this is equally essential for all colleagues within MST. Additionally, some respondents valued having control over their working hours, for one respondent this means having regular working hours, for another respondent this was great flexibility in planning their time and work. For another respondent this involved the option of remote work. Other points highlighted by a few respondents included sufficient challenge in their work, recognition and encouragement of the qualities of employees, and a more integrated approach of Positive Health. Providing a pleasant work environment with enough privacy, ergonomic office furniture and offering company fruit were also mentioned as desirable measures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePersonal measures\u003c/h2\u003e \u003cp\u003eThe personal measures that emerged include lifestyle changes (including physical activities and eating healthier), support of a professional, creating more balance (including setting boundaries, planning, setting priorities and keeping work and private life separate), (more) time in general, volunteer work, personal development and using a medical device including a sleep apnoea device.\u003c/p\u003e \u003cp\u003eOne-fifth of the respondents began making lifestyle changes related to goals in the bodily functions dimension. These changes involved engaging in physical activities, such as doing sports and changing eating habits. Several respondents were already consulting one or more healthcare professionals to work on their goals, including physiotherapists, an osteopath, a trainer in the gym, and participating in a lifestyle program. One-fifth of the respondents noted that they needed to create more balance. This could be achieved in several ways, such as setting boundaries, prioritizing, planning, and creating more spare time. Respondent 3 explained: \u003cem\u003e\u0026ldquo;Previously you said I won't come or I plan it on a working day. But now you can also join online on your days off. I am now trying to define it more and choose whether I will do it or not. And to let go at the weekend. That gives you more peace, a bit of work-life balance.\u0026rdquo;\u003c/em\u003e Another respondent (15) told: \u003cem\u003e\u0026ldquo;I need to be more aware of, it might sound strange, but actually: I put the patient on the second place. First, I need to take care of myself and then I can take care of the other.\u0026rdquo;\u003c/em\u003e A few individual respondents expressed a need for other things, such as more time, doing volunteer work, and accepting yourself. One respondent expressed: \u003cem\u003e\u0026ldquo;I would like to have more time to do more volunteer work, to support elderly people.\u0026rdquo;\u003c/em\u003e (respondent 6) One respondent needed a medical device to improve sleep quality.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e In this study, we investigated the perceived health, personal goals and ways to promote or stabilise the Positive Health of health care professionals and non-medical hospital staff of the rheumatology and cardiology department of a large tertiary hospital.\u003c/p\u003e \u003cp\u003eThe study revealed that employees are generally satisfied with their health or specific aspects of it, even in the presence of health complaints. The health complaints found were mainly physical complaints, with musculoskeletal complains being the most common. This is in line with other studies. A systematic literature review regarding the prevalence of work-related musculoskeletal disorders among health care professionals showed that health care professionals are more prone to develop musculoskeletal disorders (Suganthirababu et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Also, long covid complaints were experienced by employees. Long covid complaints among healthcare workers is reported in several other studies. (Izadi et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Peters et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)Next to physical complaints, mental health complaints were identified, such as a high workload and challenges in maintaining a good work-life balance. A review on burnout symptoms in nurses revealed a high prevalence of burnout symptoms that requires attention (Woo et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Therefore, it is crucial to address the mental health complaints of employees as identified in the study, in order to prevent burn-out.\u003c/p\u003e \u003cp\u003eThe personal goals of employees vary. Themes that emerged in the data include lifestyle, balance, meaningfulness, personal development, and social interactions. These goals are not always directly related to the health complaints that employees experience. Also, employees who are (partly) satisfied with their health have goals. To our knowledge, there are no other studies that have examined the personal goals of employees in hospitals concerning their health.\u003c/p\u003e \u003cp\u003eWhat was needed to work on the personal goals also varies. Work-related measures were receiving support from colleagues or superiors, doing other work / tasks, making ergonomic adjustments, having (more) time at work to work on tasks, increasing staff and enhancing flexibility on work. To enhance the overall health and well-being of employees, irrespective of their personal goals, employers can ensure sufficient supervisor support, empower employees to control their working hours, provide a pleasant work environment, offer company fruit, present challenging work opportunities, and integrate Positive Health within the hospital.\u003c/p\u003e \u003cp\u003ePersonal measures needed to pursue a personal goal include lifestyle changes, support of a professional, creating more balance, (more) time in general, volunteer work, personal development and using a medical device. Some of these measures were also found in other studies. One study on well-being of nurses at work found that interaction with colleagues is important for nurses\u0026rsquo; well-being (Utriainen et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Another study on the mental health and well-being of mental health nurses in the UK revealed that the subjective well-being of nurses was relatively low (Oates, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Some nurses employed strategies to enhance their well-being, both within and outside the workplace. Consistent with our study, well-being was associated with delineating clear boundaries between home and work life, participating in regular clinical supervision at the workplace, and incorporating physical exercise. Applying lessons learned from working with patients to their own lives, mindfulness practices, spending time in nature, and listening to music were not found in our study. The study underscored the importance of adopting a personalized approach, a point also highlighted in our research (Oates, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, it is noteworthy that individuals with a goal in the bodily functions dimension more often have already started working on their goal compared to those with goals in other dimensions. It is possible that initiating efforts in the bodily function dimension may be easier than in other dimensions, potentially due to a greater availability of opportunities within healthcare and the social domain to address physical health.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eA strength of the study is the use of triangulation, with multiple researchers involved in coding the interviews to enhance the reliability of the coding. Also, we included a diverse range of job function groups. A weakness of the study is that the study population mainly consists of women, so it's possible that the results may not be representative of all employees. On the other hand, the proportion of women in the study departments is also significantly higher. Due to the inclusion of two departments in the study, the findings may not be directly generalizable to the entire hospital. Another weakness is that it was not clear to all respondents what is needed to work on their personal goals. Employees did not always have an immediate answer and sometimes needed additional time for reflection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eImplications for practice\u003c/h2\u003e \u003cp\u003eThis study emphasizes the need for a personal approach in promoting the health of employees, due to varying goals and needs. Employees value the Positive Health perspective in addressing their health and well-being. A next step could be to implement the MPH tool in the workplace, for instance by incorporating this in the annual review. To start with, the employee fills in the MPH tool. Subsequently, the alternative dialogue can take place with the supervisor or another person the employee trusts, such as a confidential advisor. Together they discuss what is important, determine if there are any personal goals and what measures are needed to pursue these goals. It can also be used in a team setting, where a team will use the Positive Health spider web to explore what contribute to the ability to work in a health and enjoyable way.\u003c/p\u003e \u003cp\u003eWhen implementing Positive Health at the workplace several things are important, as described in the Dutch report on Positive Health in the workplace(Institute for Positive Health, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). For example, it is important to continuously pay attention to the Positive Health of employees, and not just at one moment. Employees indicate that filling out the MPH tool is a snapshot and that it may change over time. Therefore, it is crucial for employers to engage in ongoing conversations with employees. Besides, it is important as an employer to be able to offer a broad range of interventions to improve or stabilise the health of employees, since the needs vary.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eImplications for further research\u003c/h2\u003e \u003cp\u003eFor further research, it is interesting to quantitatively assess whether the results found in this study apply to more employees. Besides, studying the effects of applying the Positive Health framework in a workplace setting would be intriguing. It is interesting to examine whether the use of the MPH tool by employees leads to actions by the employee and/or employer and what impact this has on the health and job satisfaction of the employee.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn general, the interviewed employees experienced good Positive Health, despite the presence of complaints. Various personal goals were identified, and several measures, both work-related and personal, were needed to pursue these goals. The variation in goals and needs emphasizes the importance of a personalized approach to promote employee health. The approach of Positive Health was appreciated by employees. The alternative dialogue could be a good way to initiate a conversation with employees about their perceived health in a broad sense, and action can be taken if applicable. It can be valuable for sustainable employability, providing insight into how employers can support the health of employees. Supporting employee health is crucial for job satisfaction, delivering quality care, and retaining healthcare workers. This is especially important now, as the pressure on healthcare and its employees continues to grow due to aging populations and workforce shortages.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMPH: My Positive Health\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The research is part of the L.INT lectorate Positive Health which is partly funded from the taskforce for Applied Research SIA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Dilara Metin for the support in data collection. We would like to thank all employees that participated in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSW conducted, transcribed and analysed interviews and was responsible for acquisition of subjects, interpretation of the results and writing of this manuscript. SK and MV were responsible for the coordination of the study, the design of the study, reviewing the data analysis, interpretation of the results and reviewing this manuscript. CS conducted, transcribed and analysed interviews and was responsible for acquisition of subjects and interpretation of the results. All authors read and approved the final manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the medical-ethical review committee and the board of directors of Medisch Spectrum Twente hospital (K22-25).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants. 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J Psychiatr Res. 2020;123:9\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jpsychires.2019.12.015\u003c/span\u003e\u003cspan address=\"10.1016/j.jpsychires.2019.12.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Positive Health, Healthcare Professionals, Sustainable Employability, Occupational Health","lastPublishedDoi":"10.21203/rs.3.rs-5373578/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5373578/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe shortage of healthcare professionals, combined with the aging population, is leading to increasing pressure on healthcare professionals. To ensure that healthcare professionals are able to do their work and ensure good patient care, it is important to focus on their own health. Positive Health is a health-oriented approach and can be used for understanding and enhancing the health and well-being of healthcare professionals. The aim of the study is to gain insight in the perceived health, personal goals and how to improve or stabilise the Positive Health of employees of a large tertiary hospital in the Netherlands.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative study design was employed. Semi-structured interviews were conducted with employees (n\u0026thinsp;=\u0026thinsp;15) of the Cardiology and Rheumatology department, using the Positive Health tool. The data was analysed using thematic content analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEmployees are satisfied with their health or a specific part of their health, also when there are health complaints as well. There were personal goals in several themes being: lifestyle changes, balance, self-development, meaningfulness and social interaction. What is needed to achieve personal goals varies, also within the themes. To enhance well-being, employers can provide supervisor support, empower control over hours, create a pleasant environment, offer fruit, provide challenging opportunities, and integrate Positive Health principles.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn general, the interviewed employees experienced good Positive Health despite the presence of complaints. To enhance employee health, both work-related and personal measures were needed. The Positive Health approach was appreciated by employees and can be valuable for employers to gain insight into how to support employee health. This is particularly important given the growing pressure on the healthcare system.\u003c/p\u003e","manuscriptTitle":"Insight into perceived Positive Health of healthcare professionals. What can be done to improve and stabilize the perceived Positive Health?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-28 11:33:41","doi":"10.21203/rs.3.rs-5373578/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"202f4fa2-1ed5-45a5-bfc1-932a4851a24e","owner":[],"postedDate":"November 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-17T12:39:00+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-28 11:33:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5373578","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5373578","identity":"rs-5373578","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}