Volunteers in a hospital - opportunity or threat? Exploratory study from Finland.

Journal of Health Organization and Management Volunteers in a hospital – opportunity or threat? Exploratory study from Finland Ulla-Maija Koivula Sirkka-Liisa Karttunen

Downloaded by University of Pennsylvania Libraries At 20:44 30 January 2016 (PT)

Article information: To cite this document: Ulla-Maija Koivula Sirkka-Liisa Karttunen , (2014),"Volunteers in a hospital – opportunity or threat? Exploratory study from Finland", Journal of Health Organization and Management, Vol. 28 Iss 5 pp. 674 695 Permanent link to this document: http://dx.doi.org/10.1108/JHOM-10-2013-0218 Downloaded on: 30 January 2016, At: 20:44 (PT) References: this document contains references to 50 other documents. To copy this document: [email protected] The fulltext of this document has been downloaded 211 times since 2014*

Users who downloaded this article also downloaded: Anneli Hujala, Sanna Laulainen, Kajsa Lindberg, (2014),"Powerless positions, silenced voices? – critical views on health and social care management", Journal of Health Organization and Management, Vol. 28 Iss 5 pp. 590-601 http://dx.doi.org/10.1108/JHOM-06-2014-0106 Riitta Viitala, (2014),"Leadership in transformation: a longitudinal study in a nursing organization", Journal of Health Organization and Management, Vol. 28 Iss 5 pp. 602-618 http://dx.doi.org/10.1108/ JHOM-02-2014-0032 Anneli Hujala, Mieke Rijken, Sanna Laulainen, Helena Taskinen, Sari Rissanen, (2014),"People with multimorbidity: forgotten outsiders or dynamic self-managers?", Journal of Health Organization and Management, Vol. 28 Iss 5 pp. 696-712 http://dx.doi.org/10.1108/JHOM-10-2013-0221

Access to this document was granted through an Emerald subscription provided by emerald-srm:210680 []

For Authors If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information.

About Emerald www.emeraldinsight.com Emerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services. Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. *Related content and download information correct at time of download.

The current issue and full text archive of this journal is available at www.emeraldinsight.com/1477-7266.htm

JHOM 28,5

Volunteers in a hospital – opportunity or threat? Exploratory study from Finland

674 Received 10 October 2013 Revised 16 May 2014 Accepted 5 June 2014

Ulla-Maija Koivula School of Well-Being and Social Services, Tampere University of Applied Sciences, Tampere, Finland, and

Sirkka-Liisa Karttunen


Research, Development and Innovation, Tampere University of Applied Sciences, Tampere, Finland Abstract Purpose – Finland represents one of the Nordic welfare states where the role of the public sector as the organiser and provider of health and social care is strong. However, the amount of voluntary work in social and health care services is surprisingly big. The strongest advocates for keeping the volunteers outside are hospitals and health centres while at the same time they are suffering from shortages of staff and staff is reporting lack of time to provide needed care for their patients. The purpose of this paper is to report the results of a study of the attitudes of professionals towards voluntary work in hospitals. Design/methodology/approach – The paper is based on an exploratory study done in three hospitals, two from an urban area and one in a rural area. The interviewees represent nursing and care staff (n ¼ 21). The main questions were how staff members see options, constraints and drawbacks of volunteering regarding professional roles, work division, coordination and management. Findings – Attitudes of staff varied from positive to conditional. The approaches towards voluntary work varied from holistic to task-centred or patient-centred and were linked with organisational approach, professional approach or considerations of patients’ well-being. Critical views were expressed related to managerial issues, patients’ safety and quality of care. Increasing the amount of voluntary work done in hospitals would require a considered strategy and a specifically designed process for coordination, management and rules on the division of labour. Research limitations/implications – The research raised themes for further quantitative studies to elaborate the findings on the similarities and differences of the opinions of different staff categories and to be able to develop further the heuristic model of volunteer management triangle suggested in the paper. Social implications – The study raises questions of the need and promotion of volunteers in general and especially in health care services. It also raises critical views related to voluntary work in hospitals. Originality/value – The study is a new initiative to discuss voluntary work and how to manage volunteers in hospitals. It provides valuable knowledge for practitioners in health care involved in volunteer management and coordination. Keywords Management, Volunteer management, Health care, Volunteering, Hospital volunteering, Non-professional care Paper type Research paper

Journal of Health Organization and Management Vol. 28 No. 5, 2014 pp. 674-695 r Emerald Group Publishing Limited 1477-7266 DOI 10.1108/JHOM-10-2013-0218

Jenni Malinen, RN, participated in the research by doing and transcribing several interviews. Professor Amanda Woodward from Michigan State University commented the text and proofread the drafts. The previous version of this paper was presented in the 8th International Critical Management Studies (CMS) Conference, 10-12 July 2013, Manchester, UK. The authors thank the participants of the conference stream Critical Views on Health Care Management for their feedback.


1. Introduction Finland represents one of the Nordic welfare states where the role of the public sector as the organiser and main provider of health and social services is strong, despite the growth of the purchaser-provider model linked with new public management since the 1990s. Health and social care professions are regulated by legislation and bylaws. Formal health and social service settings, whether run by the public, private or nonprofit sector, need to follow the set qualification criteria. The role of informal care provided by relatives or unrelated volunteers is valued, but its role varies depending on the service field and service setting. The strongest bastion keeping the volunteers and informal carers outside “the fortress” is hospitals and health centres. At the same time, health care is suffering from shortages of professional staff and staff members report a lack of time to provide needed care and support for patients. This paper reports findings from a study of the attitudes and views of hospital staff towards informal care given by volunteers. The paper is based on empirical data collected through semi-structured interviews and non-active role play method in three health care institutions located in Southwest Finland, two situated in an urban area and one in a rural area. The data was collected during April-May 2013 by two researchers and a research assistant. The informants (total of 21) represent nursing staff and ward assistants working in long-term care units. The purpose of the study is to explore how staff sees the value and possibilities of volunteers as well as how they assess demands and constraints in regards to volunteer management. 2. Informal care and volunteering 2.1 Conceptual framework Volunteering is a multidimensional concept which has been defined in various ways. According to Wilson (2000, p. 215) volunteering means any activity in which time is given freely to benefit another person, group or organisation. Some definitions focus on clarifying what volunteering is not: it is not paid labour, it is not slavery or forced labour, it is not kinship care and it is not spontaneous help (Hustinx et al., 2010, p. 410). Literature reviews done by Cnaan and Amorofell (1994) and Cnaan et al. (1996) revealed that the definitions of volunteering are organised around four axes: free will, availability and nature of remuneration, proximity to the beneficiaries, and formal agency. Free will can range from one’s own internal will to a requirement by school or persuasion of others. Remuneration can vary from zero to reimbursement of expenses or time. Volunteering may be organised by a formal agency or may be a self-managed and self-appointed informal activity (Hustinx et al., 2010, p. 414). The European Council refers volunteering as “all types of voluntary activity, whether formal, non-formal or informal which are undertaken of a person’s own free will, choice and motivation, and is without concern for financial gain” (European Council, 2009/2010). The definition includes three types of volunteering: formal, non-formal and informal. Formal volunteering refers to voluntary activities that are organised by an agency. The terms of informal and non-formal volunteering are often used as synonyms and refer to unorganised, spontaneous help (Angermann and Sitterman, 2010, p. 3). There are several studies related to the scope of volunteering in European countries. A study from 27 EU countries showed that about 22-23 per cent of Europeans are involved in volunteering. Interestingly the top three countries in volunteering were Denmark, Finland and Sweden where on average about 45 per cent of adults

Exploratory study from Finland 675

JHOM 28,5


676

participate in voluntary and charitable activities (McCloughan et al., 2011, p. 13). According to the latest Euro barometer, the percentage of citizens who declare active participation in volunteering for an organisation varied from 60 per cent in Austria to 10 per cent in Bulgaria in 2006. The percentage in this study about Finland was 50 per cent. According to the latest national survey from Finland about 40 per cent of the population over ten years old had volunteered during the last 12 months (Paä¨kkonen and Hanifi, 2011). Based on these studies the total number of volunteers in Finland can be estimated to be about 1.3-1.5 million. In this research we focus on formal volunteering in health care, excluding informal volunteering. Formal volunteering in health care we define similarly to a recent literature review by the Kings Fund: “unpaid work that benefits others to whom one owes no obligation via an organisation that supports volunteering in health and social care” (Mundle et al., 2012, p. 4). 2.2 Historical evolution of volunteering in social and health care Helping each other within the family and community has existed from the dawn of mankind. As an organised activity for providing care to others, volunteering dates back to medieval times when belonging to a guild or vocational brotherhood included some obligation for mutual self-reliance. During the time of industrialisation in Finland in the late 1800s, volunteering was organised both by workers’ unions and by the bourgeoisie, especially women’s associations. The philanthropic aims behind volunteering for the poor’s well-being were mixed with political and educational ones. After the establishment of a state-based social protection system in the 1960s the state took over many of the functions that previously had been fulfilled by the informal sector. Volunteering was seen as a transitional phase which was believed to disappear in a welfare state. The vast expansion of public services during the 1970s and 1980s left little space for citizen engagement (Hilger, 2008, p. 2; Koskiaho, 2001, p. 20). Volunteering was not much appreciated and was seen partly as a threat to recent professionalisation, especially in social care. It was tolerated, however, when it filled the gaps in public services (Ruohonen, 2003, p. 46; Hilger, 2008, p. 3). The attitudes towards and the role of volunteering changed in the 1990s after the deep economic recession which resulted in cuts to public funding. The welfare mix model was introduced as a solution to the funding crisis of public services. The belief in the capacity of the public sector to carry on providing the services decreased. The Act on Informal Care Support came into force in 2006 recognising informal care given by relatives as part of the official way of providing care for the elderly or persons with a disability by introducing monetary compensation for informal carers paid by the municipality. The role of informal carers differs from that of volunteers since the former provide continuous, long-term care for at home instead of the voluntary, temporary services performed by volunteers. Politically the trend shifted towards a more pluralistic and new liberalistic welfare society with an increasing emphasis on self-reliance and mutual self-reliance. The role of associations was strengthened and new forms of partnership in service provision were created between the public sector, non-profit and for-profit sector (see, e.g. Patoma¨ki, 2007; Seppelin, 2011; Botero et al., 2012). Though people still trust in the public sector as the main responsible actor for welfare services, volunteering has increased. Volunteering in Finland is characterised by a strong membership culture in associations. Officially there are more than 120,000 registered associations out of which 70,000 are estimated to be active. In addition there are about 30,000 unregistered

associations (Harju, 2006). Around 75-80 per cent of Finns are members of voluntary organisations and many individuals hold memberships in several different organisations over the course of their lifetime (Country report Finland, 2011, p. 2). In Finland volunteering is interlinked with the third sector since non-profit organisations account for most of the volunteer services. Non-profit organisations can have various roles in present day social and health care services. These roles can vary from being a (n): .


.

.

.

service provider (similar to that of the private sector contracted for public sector work); volunteer work organiser (providing formal volunteers for institutions, e.g. hospitals, or to individuals); advocate (to represent the issues of an interest group, e.g. people with disabilities); and self-help or peer support group.

Some third sector organisations cover all these roles, while others cover just one or two. Volunteers are active in a wide variety of sectors ranging from sport to animal welfare to environmental conservation and voluntary activities relating to the armed forces. The most popular sector is sport (30 per cent), closely followed by social and health care (25 per cent), children and young people (22 per cent), religious activities (16 per cent) and community activities (10 per cent) (Country report Finland, 2011, p. 9). With about a total of 1.3-1.5 million volunteers in Finland, approximately 325,000 volunteers (25 per cent) are engaged in social and health care. However, volunteering in hospitals is a fairly recent phenomenon that has increased especially in long-term and hospice care whether run by public, non-profit or for-profit companies. 2.3 Volunteers in hospitals Though volunteering in hospitals in Finland exists, it is largely unseen and unrecognised. This is due to the fact that volunteering is often not organised and not systematically documented (Hartikainen, 2009, p. 12). The use of volunteers has sometimes been criticised as a threat to professionalism and employment. However, due to the economic constraints after the 1990s, the role of volunteers has been re-defined as being complementary to professional services and a substitute for missing patient social networks. Whether volunteers are a substitute or a complement to professionally led care is a topic for a debate. As stated by Mundle et al. (2012, p. 2), it can be both. Volunteering can take place in various health and social services: in hospitals and institutions, in housing services or group homes, in day service centres, at home and even on-line. In this study the focus is on formal volunteering taking place in a hospital setting. Informal care done by relatives or spontaneous neighbourly help is excluded from this research. Volunteering differs from informal care done by relatives in several ways: volunteers can choose when, how long and where they volunteer based on their agreement with the organisation for which they are volunteering. Volunteering is based on free will and a volunteer can stop volunteering whenever he/she wants. Being an informal carer, however, often means a long-term commitment and being available around the clock. The Figure 1 illustrates the different forms and tasks volunteers can have in health care services.


JHOM 28,5


678 Figure 1. Different roles of volunteers in health care

Volunteers as advocates and expertby-experience trainers Volunteers as providers of peer support

Hospital Volunteers as nonprofessional care assistants

Home care and home nursing Informal carers

The roles of volunteers in a health care setting can vary from “activists”, “self-helpers” and “assistants” or can be a combination of all these. Activists are involved in advocacy for a client or for a patient group, self-helpers provide peer support and peer counselling, and assistants help in care activities and thus can be an extra asset to professional staff (see Koivula, 2011, p. 149). This research focuses on volunteering as providing non-professional care in hospital settings. 3. Purpose of study and methodology 3.1 Previous research Finnish research related to volunteering, except large statistical time-use surveys by Statistics Finland (e.g. Paä¨kkonen and Hanifi, 2011), has been concentrated mostly on qualitative and micro-level studies. The majority of the studies have focused on the views and experiences of the volunteers themselves and especially on their motivation to volunteer (e.g. Yeung, 2004; Pessi, 2004; Gro¨nlund, 2012). The same applies for international research where consistently motivation has been found to be an interplay between altruism and self-interest (e.g. Wilson, 2000; Cnaan and Goldberg-Glen, 1991; Hardill and Baines, 2007; Plagnol and Huppert, 2010; Shye, 2010; Wardell et al., 2000; Stebbins, 2009.). Other popular topics have been experiences of volunteering from the perspective of clients and experiences on interaction between volunteers and clients (e.g. Hartikainen, 2009). Staff members’ point of view on volunteering has been studied in a limited way, mostly in small scale thesis works from universities of applied sciences (Haapala, 2012; Kinnunen, 2009; Kauppinen, 2012). These studies have invariably shown general attitudes towards volunteering being positive. Management and organisational aspects of volunteering has had also fairly little research attention in Finland (Ha¨nninen, 2012; Vaïsa¨nen, 2010; Koivula, 2011). In these the importance of organisation of volunteering and the need for training, coordination and motivational leadership have been raised. In the UK the Kings Fund summarised key literature on volunteering in health and social care in 2012. The review showed similar shortages of research regarding the prevalence and roles of volunteers in the health and social care sector as well as regarding strategies to attract and train volunteers (Mundle et al., 2012, p. 12, 19). 3.2 Purpose of study and methodology Previous studies in Finland have touched little upon the topic of volunteering in hospitals. To introduce volunteering in a hospital (or any other service institution)


requires coordination and collaboration by and with professional staff. Professionals by their attitudes and managers by their organisational methods can either support or hinder the implementation of volunteering and thus effect on its success or failure. The purpose of this study is to explore the attitudes of professional health care staff towards organisation of volunteering in hospitals and the important aspects of it from their point of view. Hospitals are hierarchically organised work entities with clearly defined work duties for each staff category. The uniqueness of this research is to explore how the attitudes towards volunteering and its management differ among the different staff categories or between urban and rural location of the hospital. The main research questions are the following: RQ1. How do professional staff members see the opportunities and constraints of volunteer work in a hospital environment? RQ2. How do staff members assess the conditions for volunteering from the point of view of management and organisation of volunteering in a hospital? The empirical data were collected in three public hospitals/health centres, two of them situated in urban area and one in rural area. The urban location is a city of about 200,000 inhabitants in Southwest Finland. The interviews were done in City Hospital A in its psychogeriatric ward and in two inpatient wards for the elderly and chronic patients in City Hospital B. The hospitals were selected on the basis of being the two biggest, public hospitals in the city. The rural hospital is situated in a small town of about 7,000 inhabitants also in Southwest Finland. The data was collected from two inpatient wards of Public Health Centre C which is the only primary and specialised health care provider in the municipality. The semi-structured interviews (see Appendix 1: list of questions) were done in different staff categories which include the following. Ward nurses are registered nurses who are in charge of the operational management in the ward besides their nursing duties. Registered nurses carry the responsibility of the nursing and care work in their work shift. RNs have a 3.5 years of Bachelor of Nursing Degree. Practical nurses have a three-year vocational education in social and health care. They do basic nursing tasks, care work and rehabilitation activities. Practical nurses (auxiliary nurses) also assist in feeding, dressing and personal hygiene. Of the staff members, practical nurses work most closely with patients. Ward assistants help allied health professionals in day-to-day non-medical duties of cleaning, nutritional care and transportation of patients. In long-term care units, ward assistants can also assist health care staff in care work. The duties vary depending on the ward and operational management style. In long-term care, ward assistants are important members of everyday care support, though they are not calculated as being nursing/care staff. In long-term care the minimum care staff/patient ratio is 0.6-0.7 by the quality recommendation of the Ministry of Social and Health Affairs (2013, p. 49). In average the staff category division in long-term wards are practical nurses (60 per cent) followed by registered nurses (27 per cent) and ward assistants (13 per cent) (Ruontimo, 2012). The staff categories and their number in the research data are: ward nurses (five), registered nurses (five), practical nurses (five) and ward assistants (six). Ward nurses were interviewed individually since there is only one ward nurse in each ward. Members of the other staff groups were interviewed in pairs except one practical nurse and one registered nurse who, because of time constraints, were interviewed


JHOM 28,5


680

individually. The total number of staff members interviewed was 21 with eight from the rural area and 13 from the urban area. The interviews were recorded and transcribed fully. The duration of the interviews varied from 25 minutes to 70 minutes. In addition to the interviews, a non-active role play method was used in which respondents are asked to write imaginary stories from sample episodes presented as a starting point. Narrative non-active role play method is a tool reflecting attitudes and hidden patterns of thought. Variation of sample episodes, changing the episode characteristics with positive and negative story lines, induces aspects which otherwise might not be mentioned in interviews (see Eskola, 1997; Cohen et al., 2000). In theme interviews the informants may tend to express attitudes which are socially and professionally expected and acceptable, especially when the interviews are done in groups. This was also one of the reasons to use a non-active role play. At the end of each interview the informants were asked to write a story about a day in a hospital where there are volunteers working. The beginning of the story was given to them with some receiving a positive and others a negative story line (see Appendix 2). Story lines were randomly selected for each interviewee. The total number of role play stories received was 15 with seven from the rural area and eight from the urban area. Some of the informants refused to write a role play story because they received a negative story line. Although stories were anonymous, it is possible that they did not want to express negative attitudes. Some did not return the story even though they promised to do so. The Table I summarises the types and number of data collected. The interviews were used anonymously and the names of hospitals are not mentioned in the report to ensure that the informants’ identities cannot be traced. The study permit was received from the organisations prior to the interviews in early April 2013. The data were analysed through qualitative content analysis by two researchers. One of the researchers did the initial analysis of the interviews and the other of the role play stories. The core themes found were discussed together to identify the main themes related to the research questions. Similarities and differences in the answers were examined by professional category and location (urban or rural area). The reliability of the content analysis was strengthened by using two researchers and two different sets of data which complemented each other. The interpretations were discussed and reviewed together for final results to ensure reliability. 4. Professional staff’s views on volunteer work in a hospital The results of the interviews and role play stories are first reviewed separately based on content analysis of the core themes expressed. In the discussion, the similarities and differences found by professional category and the location of the hospital are explained.

Staff category/n

Table I. Number and types of interviews

Ward nurses Registered nurses Practical nurses Ward assistants Total

Interviewed persons

Urban area

Rural area

Role play stories

Urban area

Rural area

5

3

2

3

2

1

5 5 6 21

3 3 4 13

2 2 2 8

4 4 3 15

2 2 1 8

2 2 2 7

4.1 Attitudes towards voluntary work in a hospital Generally the attitudes towards volunteering in hospital varied from positive to conditional. None of the respondents expressed negative attitudes. Volunteer work was seen as important and valued for the well-being of patients. The meaning of volunteering was seen primarily as an extra human resource in care work. The answers also reflected the staff members’ problem of having too much to do. Although generally positive, it was underlined that volunteers’ work is not the same as professional staff’s actual nursing work:


Quite positive. I am looking forward to having volunteers. When the staff ratio is what it is I am not expecting that we (professionals) get help but that the patients would get more. We are not expecting them (volunteers) to take part in actual nursing work (ward nurse, rural area). We don’t have many resources to give anything extra for patients since we do the normal nursing, so it is good that there are volunteers who can listen to the patients, perhaps read to them, and do something that we seldom have time to do [y] (registered nurse, urban area). I feel that it’s really important, especially for recreation purposes for the elderly and also for other functions here since today we take of care of everything with minimum staff, so without volunteers there is nothing for the elderly [y] (practical nurse, urban area).

The importance of volunteer work was seen especially in offering social contacts, compassion and recreation for the patients. Positive attitude towards volunteering is rooted in the well-being of the patients: There is a need since there are a lot of patients who do not have any next of kin or they live far away and the patients feel lonely, so they feel it is good that there are volunteers [y] also to be with a dying patient since we cannot release somebody to stay beside the patient all the time [y] (practical nurse, urban area). Interviewer: So why is the experience of volunteers positive then, where does it come from? Ward assistants from urban area: Because of the patient. They are the listening ears, they have time. Many others are that yeah, yeah, soon, soon. And the soon is an hour or more. And especially in the summer, they take them (patients) out and then the smiling, happy person comes back from there. They tell stories outside in a completely different way than here inside.

It was also expressed that through small, everyday things such as combing hair, reading a book, and chatting together, a personal contact can be formed with a patient. Volunteers have time for things that professional workers do not necessarily have. Also volunteers’ activities can lighten up the work of professional staff: It surely helps workers and makes the ward assistant’s work lighter (ward assistant, rural area).

However, there were also conditional points of view. From the management point of view, it was expressed that volunteering needs clarification of the roles of professional staff and volunteers: It’s really important in a geriatric ward [y] I think the colleagues think positively too but they need quite a lot of encouragement and to clarify what is their role, meaning the volunteers’ [y] Positive attitude requires that the roles are known (ward nurse, urban area).

Conditional views were raised more by nursing staff (RNs and practical nurses) than other staff members. These included the questions of responsibility of nursing, patient safety and confidentiality. In the rural area, the conditional views were raised more


JHOM 28,5

often than in the city hospitals. This might be due to the fact that in the rural hospital ward there were more patients needing acute care than in the city hospital wards: [y] patient safety issues. Anything can happen when you are dealing with a person with multiple illnesses. Who carries the responsibility in the end? Do volunteers have it or is it on their organisation or is it on the registered nurse, or on whom if something happens? (registered nurse, rural area).

682

Also, in the wards where there were more short-term patients, volunteering was not seen as important as in the long-term care wards (Table II):


Many of our patients are really ill and tired, so volunteering does not fit so well (compared to elderly care or long-term care) (practical nurse, rural area).

4.2 Requirements of a volunteer worker “Having common sense” and “being a human being to another human being” were the slogans repeated in interviews. Most of the qualifications and competences expected from volunteers were related to their personality, attitudes and motivation, rather than their actual knowledge or practical competences: To be able to be with people, and is able to [y] how to say it [y] (practical nurse A, urban area). Common sense [y] and empathy (practical nurse B, urban area). So nothing special (practical nurse A, urban area). A human being to a human being, nothing more, and it is enough (practical nurse B, urban area).

Genuine motivation to help and bring joy to the patients was seen as a key issue. As a negative example, one of the staff members in a rural area said that some volunteers have expressed curiosity about which patients are. This is a violation of confidentiality which was one of the critical issues raised in interviews. In the following, the most often mentioned expectations in the interviews are grouped into personal characteristics, practical skills, knowledge and motivation (Table III). Finding a good fit between a volunteer and a ward/a patient was considered more important than the detailed characteristics or competences of a volunteer. 4.3 Work division between professional staff and volunteers Though general attitudes were positive with some conditional remarks, the key point mentioned was to have a clear division of work between professional and volunteer workers. The core themes were related to professionalism (what is professional and what not), complexity of tasks (volunteer-related skills) and employment issues. Professionalism. Staff members expressed the division between professional and volunteer work stressing that the responsibility of care lies on the professionals. Registered nurses in particular were raising the issue and were more concerned about the patient safety issues.

Table II. Summary of basic attitudes towards volunteering

Positive

Conditional

Extra help for professionals in their work

Briefing, induction training and guidance for volunteers need to be arranged Roles between professionals and volunteers need to be clarified Confidentiality and safety of patients possible threats

Enabling more support in everyday activities for patients, especially social contacts, compassion and recreational activities

Personality and attitudes

Knowledge

Positivity, flexibility, social Code of confidentiality and outgoing personality, sense of humour, reliability Respectful attitude towards Work safety regulations patients Own initiative and activity


Having patience

Skills

Motivation

Practical skills of everyday tasks

Personal calling for volunteering

Commitment Special skills, e.g. music a plus, though not necessary Knowing and following Genuine willingness hygiene instructions to give time and joy to the patient Knowledge about hospital Continuity as a working environment (for at least a certain time period)

For example, it was registered nurses who mentioned that tasks such as helping with nutrition are not necessarily suitable for a volunteer because of the level of difficulty. Taking the patient out for a stroll in a wheelchair or for a walk was also mentioned as potentially unsafe if not done properly. On the other hand, practical nurses and ward assistants mentioned this activity as being suitable tasks for a volunteer: It should be understood, at the political level, that there is a need for professionals for certain tasks but if you just push a wheelchair out to look if the birch leaves have come out already [y] There needs to be a clear division of what you can do (practical nurse, rural area).

Registered nurses also mentioned more concerns with confidentiality, hygiene and the importance of avoiding spreading hospital bacteria. One registered nurse expressed in addition that even cleaning is not suitable for a volunteer without proper training because of the hygiene demands: [y] patient safety, that is important and also paying attention to the confidentiality and so on when you come inside the ward, those at least. It is the same thing with students or temporary workers that we assume that those things are understood and in hand but sometimes you notice that it is not so, that the lines are not clear – these are the weaknesses, safety and confidentiality (registered nurse, rural area).

It was only the staff members from the rural hospital who explicitly rose volunteering as a threat towards professional work or its value: Are they eating up our work and will the value of nurses be demoted? (practical nurse, rural area) (registered nurse, urban area).

Complexity of tasks. The tasks given for volunteers are expected to be fairly simple – not only because of the possible threat of unprofessional conduct (threat to professionalism and quality of care) but because of the anxiety too demanding tasks might arouse in volunteers: All the tasks that are given to volunteers should not be too demanding so that it creates fear and anxiety. To start with simple things to avoid anxiety. If in feeding the patient starts to gag a volunteer might think that never again. Even I, however experienced, can think in that situation that no way, I do not dare [y] (practical nurse, rural area). All other tasks (are suitable) except care tasks [y] Of course we are not saying that now take this person to a bath or to a toilet (practical nurse, urban area).


Table III. Requirements expected from a volunteer

JHOM 28,5


684

What is suitable and with whom is also dependent on the patient him/herself. The key word in the duties is “with”, with the patient, in collaboration, based on his/her needs, wishes and strengths: Something to do together with the patient, something that he/she also has strength enough, chatting, reading a paper, going to have a coffee, going out, accompanying when going for laboratory tests or other [y] (practical nurse, urban area).

The division of labour between professionals and volunteers need to be clear and none of the professional groups would assign any nursing duties and responsibility of care to volunteers. The division of professional and non-professional work needs to be maintained. However, the question of what is professional care, especially in long-term care units where patients might spend weeks or months, remains. Employment issues. Some critical views mentioned were more political and related to employment and “stealing” professionals work: If the volunteers would be taken advantage of so that they would do nursing work and then it would be questioned whether so many nurses are needed since there are these volunteers who can do the work without pay (practical nurse, urban area). Are they eating up our work and will the value of nurses be demoted? (practical nurse, rural area). Threat can be that they hijack all the space from professional work (ward nurse, urban area).

But on the contrary it was also said: It has been heard sometimes that there has been fear that nurses’ jobs are taken or something like that which is very peculiar idea today since there is work enough (ward nurse, urban area).

The themes of professionalism, complexity of tasks and employment were interrelated. As long as volunteers are doing activities which are not professional and are considered something “extra” they are welcomed and valued. What are the tasks and how to prepare the volunteers for their duties and how to organise it are questions of volunteer management. 4.4 Organisation and management of volunteering The key points in volunteer management were one of the questions in the interviews. The following is a summarisation of the main themes in the answers. Briefing the work community and creating a positive environment to accept and welcome volunteers was seen as a starting point for introducing more volunteers into the hospital environment. This was considered to be the responsibility of the management personnel of the hospital and ward. The theme of marketing the idea of volunteers was raised: Staff members need to have the right attitudes toward volunteers, that they are not coming as a nuisance and can give help in practical work. It is management’s job to market the idea both to volunteers and to the staff (registered nurse, rural area).

Induction training for volunteers was mentioned most often as a key condition and demand. The staff felt that the responsibility for this training would mostly lie on the staff working in the ward, especially on the ward nurse and nursing staff. Induction training and briefing was seen as a process starting from a general, intensive period of training provided by a volunteer organisation followed by individual guidance and support when working in the ward: Training, especially, and induction, that’s the key (ward nurse, urban area).

I’m thinking how long it would take. It should be a kind of intensive induction for all the volunteers who will join in the ward. But there are many things that cannot be clarified at once. How long should induction go on and who will take care of it [y] (registered nurse, rural area).

Exploratory study from Finland

Volunteering has to be professionally coordinated to reach the best for the patient (ward nurse, rural area).


Volunteers as partners in a working community: staff members also recognised their own role as working partners with volunteers. Collegial support and accepting volunteers as part of the working community was mentioned. Volunteers should be valued and appreciation should be shown to them:

685

We need to know who comes here and for what purpose. Maybe the collaboration ought to be more organized, not only having one coordinator [y] There could be for example some meetings at the ward, sit around the same table [y] (registered nurse, urban area). I wish that this activity (volunteering) would be prepared well so that it would work, not just that start doing [y] (ward assistant, rural area). If they are left unnoticed and they are not given enough encouragement it might be that they feel to be unwelcome [y] They should be noticed in the midst of the work rush (ward nurse, urban area).

Based on the interviews the necessary process steps needed for introducing volunteering in a hospital are mapped in the following process chart (Figure 2). Volunteering in a hospital needs to be a planned activity and a strategy set by the management. Staff members also said that volunteering needs marketing efforts to become more known. The actual organisation of volunteers and their basic training should be taken care of, not by the hospital itself, but a voluntary organisation. Volunteer training was seen as essential and important. Some suggested that volunteer workers should have a central coordinator as is done for student trainees inside the hospital. The wards would like to be involved in selecting volunteers from a rota of potential volunteers to ensure the suitability of a person. Wards would also like to carry out the responsibility of more detailed orientation to work. Written work guidelines for volunteers are needed and were already in use in Hospital B in the urban area where there had been more volunteering already. Information and marketing both externally and internally

Decision on volunteering in a hospital

Coordination and supervision

Induction training

Supporting work community including volunteers

Initial training for volunteers

Selection of volunteers

Management level: blue Volunteer organisation/centre: red Above combined: purple Ward level: yellow Nominated staff member (ward or hospital level): green

Figure 2. Process chart of necessary steps for volunteer work management

JHOM 28,5


686

Positive example of good organisation: We were told about what kind of volunteer group were trained and how many will come and work in the ward and how often they come. I think this was a good process. We were properly informed (ward nurse, urban area).

In the rural area, where volunteering was not organised yet, there were more concerns and questions about how to organise training and coordination: Whether the training should be task-centred or unit-centred, I do not know whether to train for certain tasks or more comprehensive to volunteering in a certain ward [y] (registered nurse, rural area).

The roles of the general management, volunteer organisation, a coordinating person in the hospital, and ward staff should be clear to enhance the process of volunteering. The importance of staff members in the ward to be welcoming and appreciative was also mentioned as part of a good practice. 4.5 Volunteering in hospitals: opportunity or a threat? The non-active role play method was used to lead respondents through an imaginary situation of either a positive or a negative working day in a hospital ward with volunteer workers. The different story lines were given randomly so the negativity or positivity cannot be traced back to a professional category in the results. The following two positive and negative stories are examples from stories written. As mentioned before some did not write the story and/or refused because of getting a negative start of a story. Stories had major similarities in respect of who had written them or whether they were from an urban or rural area. In total nine positive and six negative role play stories were written. Examples of positive stories: Volunteers have worked at the ward during the morning shift. They have helped the patients with breakfast time – they have received training for that from professional staff. Some of them have helped ward assistants to clear the tables. After breakfast, a volunteer worker has read aloud the news in the day room. Those patients who have had a shower have had their hair done and nails cut. Some patients have gone out with a volunteer. And one volunteer has been walking the patients with a physiotherapist (registered nurse, rural area). Volunteers come to read the newspapers for patients and take them out. Patients are enjoying these moments since nurses do not have time for this. Patients are perkier when they are able to go out for a while. Because of that they also sleep better. The working environment is more relaxed than before. Volunteers bring new inputs to the ward. Work division has not changed; nurses do the professional works and volunteers tasks are planned for them (ward assistant, rural area).

Examples of negative stories: Days are chaotic – nobody knows what volunteers are doing or where they are. Working days have become heavier than before because there are more people who are asking for help or need guidance. Work safety and patient safety has been endangered (practical nurse, urban area). The volunteer worker was obviously not motivated enough. There have been problems with patients, relatives or staff members after a good start. This spreads soon to general working atmosphere. Days are more confusing because work division is unclear. As a responsible nurse, I need to check often that agreed tasks are taken care of. Responsibility is heavy. Clearing the work duties and/or repeating the induction training might help (registered nurse, urban area).


The typical elements of positive stories and negative stories are summarised in the Tables IV and V. The threats expressed in the stories were mostly related to the volunteer workers, their motivation, skills and way of doing the work. Work division and orientation to work duties were the organisational aspect raised in the role play stories. In positive stories, volunteering brought joy to the whole community, in negative stories volunteers demanded extra work, created chaos and endangered safety. The interview data and role play method complemented each other with no major differences of themes.


5. Key findings and discussion The key findings of this explorative study are summarised in brief based on the research questions. Positive stories

Negative stories

Related to volunteer worker

Volunteer worker is active and friendly and creates good contact with patients and staff

Related to tasks

Volunteer worker is unreliable and does not come when he/she has promised Motivation is not based on helping the patients but helping him/herself Over-enthusiastic and overactive. Does not listen to patients but has his/her own interests. Does too much (interferes) or too little (lingers)

He/she helps the patient in everyday activities, is attentive to patient’s needs and interests and provides extra recreation (e.g. taking to a walk, concert and movies) He/she listens to patient’s stories and has time to chat He/she is active and shows own initiative Volunteers have received orientation to No clear knowledge of what are their work from nursing staff volunteers’ duties

Related to organisation and/management regarding volunteering Effect on patients

Effects on staff and working environment

Approach Focus

Patients are calmer and happier, atmosphere is relaxed and joyful. The depression and loneliness of patients has decreased as well as the need for medication Staff’s work has become easier and they have more time for core tasks of nursing

Patients’ safety is endangered Patients are afraid of volunteers Staff is stressed because the need to check and monitor the Table IV. work of volunteers Positive and negative Volunteer work creates story lines of volunteering confusion and chaos in the based on role play stories organisation of work

Ward nurse

Registered nurses

Practical nurses

Ward assistants

Holistic view Operational management

Task-centred view Patient-centred view Patient-centred view Professional role Patient’s well-being Patient’s well-being and safety

Table V. Dimensions of the attitudes towards volunteering by professional staff groups

JHOM 28,5


688

5.1 Differences and similarities of attitudes of professional staff Volunteer work in the hospital is seen largely as an opportunity. The value of the volunteer work is the additional social contacts and support it can provide for patients. The limitations and conditions are related mostly to the organisational and management aspects of volunteer work, especially in terms of division of work and work responsibilities and, second, to selection, training and guidance of volunteers. There were some differences between professional staff groups in relation to which kind of conditions or demands/constraints they raised. The following grouping is based on interviews where some differences could be found. The dimensions are tentative and would need more quantitative data to be verified since they might just reflect individual differences rather than differences in approach. While ward nurses looked at volunteering from the perspective of the organisation and holistic care, registered nurses thought more about specific tasks; what is possible and what is not for volunteers. Registered nurses were also more concerned about issues of patient safety and hygiene. Practical nurses and ward assistants had the most client-centred view focusing on patients’ well-being. This can be explained by the fact that these staff members actually have more person-to-person contact with clients during the day and thus see the value volunteers can bring: Even if not taking part in actual nursing work they (volunteers) can see what is happening and can notify if someone is trying to run away or something like that [y] any normal person looks around and sees if a patient is going somewhere where they should not go to (ward assistant, urban area). [y] could gain back their joy in life if he/she is depressed [y] many are afraid of death and nurses do not have time to sit beside and hold hands and be near (practical nurse, urban area).

Increasing volunteering was seen as a possibility but it would need more public marketing and collaboration with volunteer organisations. The role of the general management of the hospital is seen as an enabler and a supporter for volunteering. Volunteer organisations’ role is seen providing basic training for volunteering and brokerage services. A hospital coordinator for volunteering was seen as a possible solution for coordination of coming and going of volunteers but the actual briefing and work supervision needs to be done at the ward level. The interaction between professional staff and volunteers is a key for a positive collaboration. The views and opinions expressed were similar one of the recent studies regarding health care staff’s opinions related to training and collaboration (Kauppinen, 2012). The differences between rural and urban hospitals were small. The general attitude was positive in both locations but in the rural setting there were more issues raised concerning confidentiality and work division. Since in rural areas people are more likely to know each other, there was an explicitly expressed threat of volunteers coming to “nose around which patients are” and violating confidentiality was mentioned more often. The rural hospital offered also short-term, acute care unlike the urban hospital. This might have led to a more limited view of volunteering possibilities. The questions of work roles and limitations of tasks were also raised more frequently in the rural area but this might be due to the fact that in the urban Hospital B volunteering was a more regular thing. This leads to a conclusion that the more experience the staff members have with volunteers working in the wards, the more positive the attitudes were.


Since the study is qualitative the differences between rural and urban settings or between professional categories are preliminary and should be studied further by a quantitative study. Another option for further study could be to collect data by a diary method and/or observations. For the exploratory phase of the research combining interviews with role play method worked well and provided a lot of empirical material in a fairly short time. 5.2 Management of volunteering and professional boundaries Volunteering as complementary to hospital care work is a multifaceted issue, both an option and a threat. Options are seen in volunteering work’s complementary role to care work. Because professional staff are overloaded with work duties and need to concentrate on core tasks in times of scarce resources, volunteers offer needed human resources for more personal interaction with patients. In long-term care, patients are often left too much alone and many are lacking social contacts. The ability to go out for a stroll to smell the fresh air and see the seasonal changes of nature was most often mentioned as a single positive act that volunteers can provide for long-term patients. The benefits of volunteering were, first, seen to bring more comfort and well-being to patients, adding a human touch to health and social care. This is a similar finding to other studies (e.g. Casiday et al., 2008). Though in Finland the use of volunteers in hospitals is a fairly recent and rare phenomenon, volunteers are regarded in this study as an “add on”. Volunteers were seen as enabling the staff to concentrate to their core tasks. Volunteers were regarded as providing something “extra”. These results are similar to a study published by the Kings Fund in England (Naylor et al., 2013, pp. 14-15). This raises a fundamental question of what is wrong in health care when professional staff do not have time to provide humanistic care for patients. Should not listening and talking, sitting and chatting with a depressed or anxious patient be one of the core tasks of nurses? Where does the time go? Volunteering can provide some help but it will not solve the basic problem. It might even make it worse if nursing and care workers’ tasks are even more tightly defined with volunteers doing the “soft side”. It has been noted that the tendency of defining the volunteer work as mainly “non-political” service work (excluding advocacy and social activism) and encouraging partnership structures is part of the neoliberal agenda to decrease the responsibility of the welfare state (Hustinx et al., 2010, p. 428; Musick and Wilson, 2008, p. 521). Is organising and developing more opportunities for volunteering a double-edged sword which eventually will reformulate the tasks of nurses and ward assistants as well? The main argument against this threat is the fact that volunteering cannot be guaranteed to be permanent. The so called episodic volunteers have increased compared to traditional volunteers who are committed to volunteer for a certain organisation or service (Brudney and Meijs, 2009, p. 564). Volunteering is just what it is; volunteering, which might be plenty on one day, and virtually non-existent on another day. Recent research suggests that, compared with traditional volunteering as an enduring commitment, the new volunteerism is characterised by episodic volunteer efforts (Hustinx et al., 2010, p. 426). Volunteering benefits the patient/beneficiary but also gives meaning and satisfaction to the volunteer him/herself. Thus volunteers can only be managed by motivation, appreciation and support. But volunteering cannot be introduced without organisation and management of the volunteer process. Success in volunteering needs preparation of both staff and the


JHOM 28,5


690

volunteers themselves. The most often mentioned condition for volunteering was the clarity of work roles and division of work. The boundaries of work appear differently depending on the work role. For example, what might be perceived as help from the practical nurses point of view might be perceived as a violation and “taking a job away” from ward assistants’ point of view (see Hoad, 2002). The essence of volunteering is that it is a voluntary rather than a contractual relationship. Thus voluntary organisations or institutions such as hospitals cannot define tasks and oblige voluntary work to happen, but can only provide the structures and framework to make it possible (Hoad, 2002). For volunteering to become an integral part of care requires that a strategy be created and approved at the management level. Figure 3 illustrates a heuristic model of the triangle of volunteer management. The strategy should clearly state what is understood about volunteering, how it is defined and what is its purpose and role at a hospital. Based on the strategy, the division of professional care, paid work and the role of volunteering should be clarified. In the context of USA, Pynes and Lombardi (2012, pp. 135-151) describe the essential and important role of volunteers in health care services, almost as a necessity. But their role is also much more versatile than was assumed in the answers of the respondents in this study. Respondents thought volunteering being mainly interaction with patients and assisting in care but in the USA, the volunteers are more involved, e.g. in office work, business activities (e.g. gift shop, cafeteria) and community relations. Pynes and Lombardi also stress the strategic placement of volunteers as important decision of the organisation. Tang and Morrow-Howell (2008, p. 211) predict that the demand for volunteers will continue to increase as resources shrink and demand for services grow. From the staff point of view volunteers would need both basic training about volunteering (e.g. by a voluntary organisation) and induction training at the ward level when starting their work as volunteers. Coordination and management of volunteer workers needs to be an organised process and the role of a volunteer coordinator at the hospital level and the ward nurses or colleagues at ward levels needs to be defined. The threat to volunteer management is that it becomes multi-layered and too complex.

Strategy

Coordination and management

Induction and training

Process

Figure 3. The triangle of volunteer management

Professional care

Division of work

Voluntary work: nonprofessional care


Also with the emerging increase of episodic or periodic volunteers challenges the more traditional volunteer management where volunteers are expected to commit themselves to a certain organisation (see Macduff et al., 2009, pp. 404, 409-410). The answers of the respondents of this study suggest that the image of volunteering follows this traditional model. Volunteering management is one type of hybrid management (Evers, 2004) where management inside organisation is not enough but managers need to be able to manage networks and to form strategic alliances. Volunteers are a resource in health and social care which is increasingly needed because of the constraints faced in public funding, leading to more scarce human resources in care. To become an integrated and complementary part of care services volunteering needs an organisational-level strategy, encompassing the multifaceted nature of volunteer tasks possible as well as the various types of volunteers. Volunteering in hospitals can be an option to provide complementary care benefitting both personnel and patients but only if there is mutual trust and collaboration between professional staff, volunteers and, also, patients’ relatives who also might have some controversial feelings or attitudes towards volunteer help. References Angermann, A. and Sitterman, B. (2010), “Volunteering in the European union – an overview”, Working Paper No. 2, The Observatory for Socio-Political Developments in Europe, Institute for Social Work and Social Education, Frankfurt am Main, available at: http:// bmsk2.cms.apa.at/cms/freiwilligenweb/attachments/3/1/3/CH1073/CMS1292419657374/ working_papier_no_2_observatory_volunteering_in_the_eu_overview%5B1%5D.pdf (accessed 15 May 2013). Botero, A., Paterson, A.G. and Saad-Sulonen, J. (Eds) (2012), “Towards peer production in public services: cases from Finland”, Aalto-University Publications 15, Helsinki, available at: http://co-p2p.mlog.taik.fi/files/2012/06/p2p-public-services-finland-2012.pdf (accessed 30 May 2013). Brudney, J.L. and Meijs, L.C.P.M (2009), “It ain’t natural. Towards a new (natural) resource conceptualization for volunteer management”, Non-Profit and Voluntary Sector Quarterly, Vol. 38 No. 4, pp. 564-581. Casiday, R., Kinsman, E., Fisher, C. and Bambra, C. (2008), Volunteering and Health: What Impact Does It Really Have? Report to Volunteering England, Volunteering England, London. Cnaan, R.A. and Amorofell, I.M. (1994), “Mapping volunteer activity”, Non-Profit and Voluntary Sector Quarterly, Vol. 23 No. 4, pp. 335-351. Cnaan, R.A. and Goldberg-Glen, R.S. (1991), “Measuring motivation volunteer in human services”, Journal of Applied Behavioural Science, Vol. 27 No. 3, pp. 269-285. Cnaan, R.A., Handy, F. and Wadsworth, M. (1996), “Defining who is a volunteer: conceptual and empirical considerations”, Non-Profit and Voluntary Sector Quarterly, Vol. 25 No. 3, pp. 364-383. Cohen, L., Manion, L. and Morrison, K. (2000), Research Methods in Education, Routledge Farmer, London. Country report Finland (2011), “Study on Volunteering in the European Union”, available at: http://ec.europa.eu/citizenship/eyv2011/doc/National%20report%20FI.pdf (accessed 9 September 2011). Eskola, J. (1997), Elaÿtymismenetelmaöpas (Role Play Method Guidebook), Tampereen yliopisto, Tampere.


JHOM 28,5


692

European Council (2009/2010), “Council decision of 27 November 2009 on the European year of voluntary activities promoting active citizenship (2010/37/EC)”, Official Journal of the European Union, 22 January, pp. 43-49, available at: http://ec.europa.eu/citizenship/pdf/ 20091127_council_decision_en.pdf (accessed 1 September 2011). Evers, A. (2004), “Mixed welfare systems and hybrid organisations – changes in the governance and provision of social services”, paper presented at the Sixth International Conference of the International Society for Third-Sector Research Ryerson University and York University, Toronto, July 11-14, available at: http://c.ymcdn.com/sites/www.istr.org/ resource/resmgr/working_papers_toronto/evers.adalbert.pdf (accessed 31 January 2014). Gro¨nlund, H. (2012), Volunteerism as a Mirror of Individuals and Society: Reflections from Young Adults in Finland, University of Helsinki, Helsinki, available at: http://urn.fi/ URN:ISBN:978-952-10-7938-2 (accessed 14 May 2013). Haapala, I. (2012), Vanhuspalvelutyo¨ntekijoïden na¨kemyksia¨ vapaaehtoisesta vanhustyo¨sta¨ (Elderly Care Workers’ Opinions on Volunteers in Services for the Elderly), Tampereen ammattikorkeakoulu, Tampere, available at: http://publications.theseus.fi/bitstream/ handle/10024/52168/OPINNAYTETYO.pdf?sequence¼1 (accessed 5 April 2013). Ha¨nninen, T. (2012), “Noÿra¨, ymma¨rta¨va¨ ja kannustava”, Suomen Punaisen Ristin vapaaehtoistyo¨n johtamisen kehitta¨mishaasteet (Humble, understanding and encouraging. Development challenges of the management of volunteering at the Finnish Red Cross), Pohjois-Karjala University of Applied Sciences, Joensuu. Harju, A. (2006), Finnish Civil Society, KVS Foundation, Helsinki. Hardill, I. and Baines, S. (2007), “Volunteering for all? Explaining patterns of volunteering and identifying strategies to promote it”, Policy and Politics, Vol. 35 No. 3, pp. 395-412. Hartikainen, A. (2009), Vapaaehtoiset vuodeosastolla. Etnografinen tutkimus vanhusten ja vapaaehtoisten kohtaamisesta (Volunteers at Hospital Wards. Ethnographic Research on Interaction Between Elderly People and Volunteers), University of Helsinki, Helsinki. Hilger, P. (2008), “A case of human service dominance: volunteer centres in Finland”, paper prepared for the Volunteering Infrastructure and Civil Society Conference, Aalsmeer, 24-25 April. Hoad, P. (2002), “Drawing the line: boundaries of volunteering in the community care of older people”, Health and Social Care in the Community, Vol. 10 No. 4, pp. 239-246. Hustinx, L., Cnaan, R.A. and Handy, F. (2010), “Navigating theories of volunteering: a hybrid map for a complex phenomenon”, Journal for the Theory of Social Behaviour, Vol. 40 No. 4, pp. 410-434. Kauppinen, T. (2012), Hoitotyo¨ntekijoïden kokemuksia vapaaehtoistoiminnasta (Nursing Staff’s Experiences from Voluntary Activity), Diacony University of Applied Sciences, Helsinki. Kinnunen, T. (2009), Vapaaehtoistoiminta ja Ammatillinen tyo¨ – Toistensa Taÿdenta¨jia¨? (Voluntary Work and Professional Work – Complementing Each Other? Diacony University of Applied Sciences, Helsinki. Koivula, U.-M. (2011), “Volunteering and social capital in elderly care”, in Manninen, O. (Ed.), Work Among the Elderly, Tampere Adult Educational Centre, Work Life Ability Networks, The ISCES-Society, Tampere, pp. 145-158. Koskiaho, B. (2001), “Sosiaalipolitiikka ja vapaaehtoistyo¨ (Social policy and volunteering)”, in Eskola, A. and Kurki, L. (Eds), Vapaaehtoistyo¨ auttamisena ja oppimisena (Volunteering as Helping and Learning), Vastapaino, Jyva¨skyla¨, pp. 15-40. McCloughan, P., Batt, W.H., Costine, M. and Scully, D. (2011), “Second European quality of life survey”, Participation in Volunteering and Unpaid Work European Foundation for the Improvement of Living and Working Conditions, available at: www.eurofound.europa.eu/ publications/htmlfiles/ef1102 (accessed 2 September 2011).


Macduff, N., Netting, F.E. and O’Connor, M.K. (2009), “Multiple ways of coordinating volunteers with differing styles of service”, Journal of Community Practice, Vol. 17 No. 4, pp. 400-423. Ministry of Social and Health Affairs (2013), “Laatusuositus hyva¨n ikaä¨ntymisen turvaamiseksi ja palvelujen parantamiseksi (Quality recommendation for securing good ageing and service development)”, Publications No. 11, Juvenes Print, Helsinki, available at: www.stm.fi/c/document_library/get_file?folderId¼6511564&name¼DLFE-26915.pdf (accessed 10 February 2014). Mundle, C., Naylor, C. and Buck, D. (2012), “Volunteering in health and care in England”, Kings Fund, London, available at: www.kingsfund.org.uk/sites/files/kf/field/field_related_ document/volunteering-in-health-literature-review-kingsfund-mar13.pdf (accessed 21 June 2013). Musick, M.A. and Wilson, J. (2008), Volunteers: A Social Profile, Indiana University Press, Bloomington, IN. Naylor, C., Mundle, C., Weaks, L. and Buck, D. (2013), “Volunteering in health and care. Securing a sustainable future”, The King’s Fund, London, available at: www.kingsfund.org.uk/sites/ files/kf/field/field_publication_file/volunteering-in-health-and-social-care-kingsfundmar13.pdf (accessed 1 March 2014). Paä¨kkonen, H. and Hanifi, R. (2011), “Ajankaÿto¨n muutokset 2000-luvulla. (Changes in time use during 21st century)”, Statistics Finland, Helsinki, available at: http://tilastokeskus.fi/tup/ julkaisut/tiedostot/isbn_978-952-244-331-1.pdf (accessed 10 January 2014). Patoma¨ki, H. (2007), Uusliberalismi Suomessa: lyhyt historia ja tulevaisuuden vaihtoehdot (New Liberalism in Finland: Short History and Future Alternatives), WSOY, Helsinki. Pessi, A.B. (2004), “Civil society, social capital and volunteering in Finland. Contemporary trends in Finnish volunteering”, Nordic Journal of Religion and Society, Vol. 16 No. 1, pp. 63-80. Plagnol, A. and Huppert, F. (2010), “Happy to help? Exploring the factors associated with variations in rates of volunteering across Europe”, Social Indicators Research, Vol. 97 No. 2, pp. 157-176. Pynes, J.E.L. and Lombardi, D.N. (2012), Human Resources Management for Health Care Organizations: A Strategic Approach, Wiley, Hoboken, NJ. Ruohonen, M. (2003), “Ja¨rjesto¨t vapaaehtoistoiminnan areenoina (Associations as arena for volunteering)”, in Niemela¨, J. and Dufva, J. (Eds), Hyvinvoinnin arjen asiantuntija: Sosiaalija terveysja¨rjesto¨t uudella vuosituhannella (Everyday Life Welfare: Social and Health Organisations in the New Millenium), PSkustannus, Jyva¨skyla¨, pp. 40-55. Ruontimo, T. (2012), “Henkilo¨sto¨mitoituksen hallittu tulevaisuus (Controlled nurse staffing in future)”, Tehy Publications B2, Multiprint Oy, Vantaa, available at: www.tehy.fi/@Bin/ 22718216/Henkil%C3%B6st%C3%B6mitoitus_netti.pdf (accessed 11 February 2014). Seppelin, M. (2011), Sosiaali- ja terveysalan kansalaisja¨rjesto¨t sosiaalija terveysministerio¨n kumppaneina (Social and Health Care Associations as Partners with the Ministry of Social and Health Care), Ministry of Social and Health Care, Helsinki. Shye, S. (2010), “The motivation to volunteer: a systemic quality of life theory”, Social Indicators Research, Vol. 98 No. 2, pp. 183-200. Stebbins, R. (2009), “Would you volunteer?”, Society, Vol. 46 No. 2, pp. 155-159. Tang, F. and Morrow-Howell, N. (2008), “Involvement in voluntary organizations: how older adults access volunteer roles?”, Journal of Gerontological Social Work, Vol. 51 Nos 3-4, pp. 210-227. Vaïsa¨nen, M. (2010), “Toimintamalli vapaaehtoistoimijoiden johtamiseen (Practice model for managing volunteers)”, Verkostojohtamisen JET-tutkinto, available at: www.espoonvapa aehtoisverkosto.fi/dokumentit/Toimintamalli_johtamiseen.pdf (accessed 1 May 2014).



JHOM 28,5

Yeung, A.B. (2004), Individually Together: Volunteering in Late Modernity: Social Work in the Finnish Church, The Finnish Federation for Social Welfare and Health, Helsinki. Wardell, F., Lishman, J. and Whalley, L.J. (2000), “Who volunteers?”, British Journal of Social Work, Vol. 30 No. 2, pp. 227-248. Wilson, J. (2000), “Volunteering”, Annual Review of Sociology, Vol. 26, August, pp. 215-240.

694

Further reading Hilger, P. (2006), Organising volunteers: Activating Infrastructures and Reflexive Volunteering in the Municipality of Helsinki, Urban Research Unit, Helsinki. Nylund, M. and Yeung, A.B. (2005), Vapaaehtoistoiminta – anti, arvot ja osallisuus (Volunteering – Worth, Values and Participation), Vastapaino, Tampere. Pessi, A.B. and Oravasaari, T. (2010), “Kansalaisja¨rjesto¨toiminnan ytimessa¨. Tutkimus RAY:n avustamien sosiaalija terveysja¨rjesto¨jen vapaaehtoistoiminnasta (In the core of civil activity. research on volunteering in social and health care associations)”, Reports No. 23, RAY, Helsinki. Volunteering in the European Union (2010), “Educational, audiovisual & culture executive agency (EAC-EA)”, Directorate General Education and Culture (DG EAC), final report, 17 February, available at: http://ec.europa.eu/citizenship/pdf/volunteering-in-the-eu-finalreport.pdf (accessed 1 September 2011). Appendix 1. List of interview questions (1)

What is your opinion and attitude towards volunteering in a hospital? What do you think your colleagues are thinking about it?

(2)

What kind of experiences about volunteering in hospital you have?

(3)

What is required from volunteer organisation and management?

(4)

.

From professional staff?

.

From ward management?

.

From general management?

.

From others?

What are the tasks and roles volunteers can have? .

Most suitable tasks

.

Competences required

.

Attitudes

.

Work division and roles in relation to professional staff

.

Coordination

(5)

What are the weaknesses or negative things in volunteering in a hospital?

(6)

What are the strengths and positive things in volunteering in a hospital?

(7)

What kind of possibilities there are to increase volunteering in a hospital, in practice?

(8)

What kind of threats do you see in volunteering in a hospital? How to relieve them?

(9)

Other comments related to volunteering in a hospital and toward management and coordination of it?


Appendix 2. Role play story A. Positive story line It is April in 2016. Blue violets are already blooming. You are just about to finish your shift in the hospital. You are thinking how nice day it was. From the time that volunteers have come to help the professionals all is going better. Both the patients and the staff are enjoying themselves. Please write a small story what has happened? How days are going compared to earlier? What has improved in work, work environment, work division, atmosphere or in other work related things? B. Negative story line It is April in 2016. Blue violets are already blooming. You are just about to finish your shift in the hospital. You are thinking how awful day it was. From the time that volunteers have come to help the professionals all has gone for worse. Both the patients and the staff are complaining. Please write a small story what has happened? How days are going compared to earlier? What has weakened in work, work environment, work division, atmosphere or in other work related things? About the authors Professor Ulla-Maija Koivula has majored in Social Policy and Sociology and has also an MBA Degree specialised in Social and Health Care Management. She has worked as a Principal Lecturer in social services and social and health care management for over 20 years. She has been involved in various RDI projects related in social sector management and project evaluation. She has also been involved in international projects in development of social services and social protection strategies. Professor Ulla-Maija Koivula is the corresponding author and can be contacted at: [email protected] Dr Sirkka-Liisa Karttunen has majored in health care and has a long career working as a nurse and health care manager before entering to education sector where she has worked for about 20 years. She is presently working in RDI projects and in further education programmes related to social and health care.

To purchase reprints of this article please e-mail: [email protected] Or visit our web site for further details: www.emeraldinsight.com/reprints


Change--threat or opportunity.

E-cigarettes: threat or opportunity?

Midcareer Transition in Radiology: Threat or Opportunity?

Intensive Care at Home: An Opportunity or Threat.

Patients covertly recording clinical encounters: threat or opportunity? A qualitative analysis of online texts.

Internet use and suicidal behaviors: internet as a threat or opportunity?

CAUTI Surveillance: Opportunity or Opportunity Cost?

Hospital admission--a missed opportunity to immunise.

Increasing incidence of bullous pemphigoid in Northern Finland: a retrospective database study in Oulu University Hospital.

Humblebrag: shortcoming or opportunity?

Goitre or "goiter"--a missed opportunity?

Hospital boarder babies and their families: an exploratory study.

Psychotropic drugs and homicide: A prospective cohort study from Finland.

[Hospital admission: An opportunity for diabetes screening].

Trauma in the elderly: Burden or opportunity?

Community hospital continuing medical education--a missed opportunity.

An Exploratory Descriptive Study of Antimicrobial Resistance Patterns of Staphylococcus Spp. Isolated from Horses Presented at a Veterinary Teaching Hospital.

The development of differences in hospital costs accross income groups in Finland from 1998 to 2010.

Clostridium difficile spores: a major threat to the hospital environment.

Hospital treatment of addicts arrested for intoxication in Finland.

Occurrence of malocclusion in attritive environment: a study of a skull sample from southwest Finland.

HIV 2: A Benign Onlooker or A Subtle Threat?

Hospital variation in mortality from cardiac arrest after cardiac surgery: an opportunity for improvement?

Psychiatry - recruitment crisis or opportunity for change?