Supporting "two-getherness": assumption for nurse managers working in a shared leadership model

Organisational and leadership skills towards healthy workplaces: an interview study with registered nurses in Sweden

BACKGROUND

According to shortage of registered nurses, organisational and leadership aspects grounded in person-centrered approach, are highlighted to ensure high quality of care. Therefore, it is interesting to develop knowledge regarding registered nurses working environment.

AIM

The aim of the study was to investigate registered nurses' reason to end their employment at a university hospital setting (internal medicine, emergency department).

METHOD

Qualitative content analysis with an inductive methodological approach was used to analyse registered nurses' experiences regarding their former employment. Inclusion criteria; all nurses (n = 55) who ended employment during one year (first of July 2020-30th of June 2021) were invited, and 38 semi-structured interviews were conducted.

RESULTS

Three categories were identified: Limited organisational support, Lack of visible leadership, and Limited healthy working environment, followed by six subcategories: Longing for organisational support, Being a tile in a box, Need for professional relationship, Limitation of supportive leadership, Imbalance of work versus personal life, and Ethical stress.

CONCLUSION

To improve registered nurses working environment and commitment to work, balance between time at work and personal life is significant. Therefore, organisational support and leadership skills grounded in a person-centred approach are crucial to develop a healthy working environment. A person-centred leadership could improve collaboration and shared decision-making in partnership with those involved, managers, nurses, and team members.

Fifty-five years of managerial shared leadership research: A review of an empirical field

Managerial shared leadership is a practice that goes beyond traditional ways of organising leadership functions. It is an organisational phenomenon where a few individuals share responsibility for the tasks of a managerial position. This paper reviews 67 empirical papers published in scientific journals. The review covers 55 years (1965–2019). The aim is to contribute knowledge about managerial shared leadership as a research field and offer some relevant theoretical concepts. No review to date has specifically focused on managerial shared leadership, and this paper intends to close this knowledge gap. The paper details the start of managerial shared leadership as a research field, presents a bibliometric analysis and the methodological approaches used, and describes the structural characteristics of managerial shared leadership. The paper includes a thematic content analysis of necessary and enabling antecedents and outcomes. Historically, the imprecise use of concepts has hampered managerial shared leadership’s development into a cohesive research field, so this paper develops and uses theoretical concepts to form a theoretical construct for the entire field. This construct is briefly discussed in relation to general shared leadership theory and critical leadership studies. In practice, managerial shared leadership may provide leadership solutions where there is an imbalance between demands and resources while managing complex situations.

Exploring the factors that influence healthcare providers care quality in Jordanian hospitals: the perspectives of nurses, pharmacists and physicians

Objectives

The key point of this investigation is to explore factors that influence healthcare providers’ quality care in government hospitals in Jordan, from the perspective of nurses, pharmacists and physicians.

Method

A qualitative technique (case study) was executed in this project. Semi-structured interviews (face-to-face) were used. The thematic analysis was applied in this study. The interviews were conducted with five physicians, five pharmacists and five nurses at different levels, including different specialists from Jordanian government hospitals.

Key findings

Four vital factor influencing of nu healthcare providers’ quality care were recognised in the sampled hospitals: manager ability and leadership support of staff, adequate and qualified hospital nurses and physicians, building a trusting work environment and good salaries and incentive.

Conclusions

This examination attempted to offer an in-depth comprehending factor that impacts healthcare providers’ quality care. Furthermore, it contributes to healthcare theory and practice by developing a conceptual framework that offers policymakers and managers a practical understanding of factors that influence healthcare providers’ quality care.

Social determinants of the impact of hospital management boards on quality management: a study of 109 European hospitals using a parsonian approach

Background

The consolidated framework for implementation research states that personal leadership matters in quality management implementation. However, it remains to be answered which characteristics of plural leadership in hospital management boards make them impactful. The present study focuses on social determinants of implementation power of hospital boards using Talcott Parsons’ sociological concept of adaptation, goal attainment, integration, and latency (AGIL), focusing on the G (goal attainment) and I (integration) factors of this concept. The study aims to test the hypothesis that hospitals with management boards that are oriented toward the quality goal (G) and socially integrated (I) (GI boards) are better at implementing quality management than hospitals with boards lacking these characteristics (non-GI boards).

Methods

A cross-sectional mixed-method design was used for data collection in 109 randomly selected hospitals in seven European countries. Data is based on the study “Deepening our understanding of quality improvement in Europe” (DUQUE). We used responses from (a) hospitals’ chief executive officers to measure the variable social integration and the variable quality orientation of the board and (b) responses from quality managers to measure the degree of implementation of the quality management system. We developed the GI index measuring the combination of goal-orientation and integration. A multiple linear regression analysis was performed.

Results

Hospitals with management boards that are quality oriented and socially integrated (GI boards) had significantly higher scores on the quality management system index than hospitals with boards scoring low on these features, when controlled for several context factors.

Conclusions

Our findings suggest that the implementation power of hospital management boards is higher if there is a sense of unity and purpose within the boards. Thus, to improve quality management, it could be worthwhile to increase boards’ social capital and to increase time designated for quality management in board meetings.

Zwischen Traum und Trauma - Aufbau und Betrieb einer Kohortenstation für Patient_innen mit COVID-19 in einem Akutspital - Eine Fallstudie

Between dream and distress - Setting up and running a cohort ward for COVID-19 Patients at an acute hospital - A case study Abstract. Background: In the context of the pandemic, hospitals must be able to care for COVID-19 patients within a very short timeframe.

OBJECTIVE

Description of the setting up of a cohort ward for patients with COVID-19 on a surgical ward including the development of the nursing team.

METHODS

The intrinsic retrospective case study describes the situation, identifies special phenomena in a reflective manner and links them to existing knowledge. Data were anecdotal, routine data were collected in the context of nursing practice development.

RESULTS

Setting up the cohort ward in a Swiss hospital consisted of structural and technical planning, infection control measures, the establishment of interprofessional structures, and internal communication. During the four-week operation, 71 patients were treated. The use of practice development methodology initiated a cultural change. The reflection describes a field of tension between "dream and distress": As a dream, the lived experience of optimal care, with well-functioning processes, sufficient material, sufficient personnel and a very good interprofessional cooperation was evaluated. Distress in the form of high infection rates as well as psychological and physical stress did not occur. After the cohort ward was closed, there was a risk working back in normal operations based on existing economical and organizational conditions, with the knowledge that a different cooperation and organization is possible.

CONCLUSIONS

Positive experiences from the "crisis mode" should be used to further develop essential operations during normal times.

International Nursing: Caring in Nursing Leadership-A Meta-ethnography From the Nurse Leader's Perspective

To explore and derive new conceptual understanding of nurse leaders' experiences and perceptions of caring in nursing.

RESEARCH QUESTION

What is caring in nursing leadership from the nurse leaders' perspectives? There is a paucity of theoretical studies of caring in nursing leadership. Noblit and Hares interpretative meta-ethnography was chosen because of its interpretative potential for theory development. Caring in nursing leadership is a conscious movement between different "rooms" in the leader's "house" of leadership. This emerged as the metaphor that illustrates the core of caring in nursing leadership, presented in a tentative model. There are 5 relation-based rooms: The "patient room," where nurse leaders try to avoid patient suffering through their clinical presence; the "staff room," where nurse leaders trust and respect each other and facilitate dialogue; the "superior's room," where nurse leaders confirm peer relationships; the "secret room," where the leaders' strength to hang on and persist is nurtured; and the "organizational room," where limited resources are continuously being balanced. Caring in nursing leadership means nurturing and growing relationships to safeguard the best nursing care. This presupposes that leaders possess a consciousness of the different "rooms." If rooms are not given equal attention, movement stops, symbolizing that caring in leadership stops as well. One room cannot be given so much attention that others are neglected. Leaders need solid competence in nursing leadership to balance multiple demands in organizations; otherwise, their perceptiveness and the priority of "ministering to the patients" can be blurred.

I Stay-Swedish Specialist Nurses in the Perioperative Context and Their Reasons to Stay at Their Workplace

PURPOSE

To investigate why nurse anesthetists and operating room nurses choose to stay in the same workplace.

DESIGN

Qualitative design.

METHODS

Individual interviews were conducted with 15 nurse specialists from four hospitals in Sweden. Two men and 13 women aged between 43 and 63 participated. Data were analyzed with systematic text condensation according to Malterud.

FINDINGS

Three themes were identified. (1) Organizational stability contributed to low staff turnover, with good spirits between colleagues, representing everyone's equal value and resulting in a feeling of homelikeness. (2) Sustained development in one's own profession. (3) A humane head nurse who was at hand, who was a facilitator, who knew staff members, and eliminated obstacles for them.

CONCLUSIONS

In a nonhierarchical and stable organization with a head nurse with caritative leadership skills, a welcoming working environment with opportunities for professional development is created. Thus, nurse specialists choose to stay, contributing to organizational development.

Going beyond "two-getherness": Nurse managers' experiences of working together in a leadership model where more than two share the same chair

OBJECTIVE

To explore nurse manager experiences of working in leadership constellations where more than two managers share leadership, and to compare this multilateral sharing form to what is known about experiences of working in joint leadership in pairs.

DESIGN AND SETTING

A qualitative design based on semi-structured interviews with nurse managers in two multilaterally shared leadership constellations at two intensive care units at an emergency hospital in Sweden. Data were analysed using a thematic and comparative approach.

FINDINGS

The comparative analysis identified four aspects that differ decisively from the positive picture in the literature on joint pair leadership: the perception of mandate with reduced decision-making power and reduced access to forums, the way of working with a strict division of tasks and a rotating schedule, a need to cope with the increasing number of internal relations and a feeling of doubt concerning trust.

CONCLUSION

Shared leadership between nurse managers has gone from being a tight collaboration based on a feeling of "two-getherness", to being an organisational solution multilateral in character. In this transformation, a weakening of leadership qualities has occurred. Further research is necessary on how this new organisational solution impacts the nurse managers, their staff and the care provided in healthcare organisations generally.

Person-centred care: A qualitative study on first line managers’ experiences on its implementation

Person-centred care is an up-and-coming care model for reducing fragmentation in healthcare by using the core component partnership between patients and care providers. Therefore, it is important to develop knowledge of the implementation processes. The overall aim of this qualitative study was to describe managers’ experiences of the implementation of person-centred care. This paper provides an example of how person-centred care was implemented in the medical department of a hospital in the western part of Sweden. The study comprised eight interviews with first-line managers, and the data were analysed using qualitative content analysis. The results formed three categories, structured approach – to be organized; care planning – to be continued and teamwork – to be together, that describe the implementation of person-centred care from philosophy to practice application. Managerial skills of first-line managers are key components to developing a structured approach that improves and develops person-centred care, i.e. work together towards the mutual care plan. Continuous cooperation within and across organizational boundaries is needed (synergy effect) to decrease high working load when person-centred care is implemented to improve quality of care.

Co-Leadership - A Management Solution for Integrated Health and Social Care

INTRODUCTION

Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers - each manager representing one of the two principal organizations in integrated health and social care services - was explored.

AIM

To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care.

METHOD

Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers.

RESULTS

Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care.

CONCLUSION AND DISCUSSION

Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability.

To be involved - A qualitative study of nurses' experiences of caring for dying patients

OBJECTIVE

The aim of this study was to describe nurses' experiences (>two years) of caring for dying patients in surgical wards.

BACKGROUND

Palliative care is included in education for nurses. However, the training content varies, and nurse educators need to be committed to the curriculum regarding end-of-life situations. A lack of preparation among newly graduated nurses regarding dying and death could lead to anxiety, stress and burnout. Therefore, it is important to improve knowledge regarding end-of-life situations.

SETTING, PARTICIPANTS AND METHOD

A qualitative descriptive study was carried out in two surgical wards in the southern part of Sweden. The study comprised six interviews with registered nurses and was analysed using manifest qualitative content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nurses' perspectives and thoughts regarding dying patients.

RESULTS

The results formed one category (caring-to be involved) and three subcategories (being supportive, being frustrated and being sensitive in the caring processes). Nurses were personally affected and felt unprepared to face dying patients due to a lack of knowledge about the field of palliative care. Their experiences could be described as processes of transition from theory to practice by trial and error.

CONCLUSION

Supervision is a valuable tool for bridging the gap between theory and practice in nursing during the transition from novice to expert. Improved knowledge about palliative care during nursing education and committed nursing leadership at the ward level facilitate preparation for end-of-life situations.

The visualisation of clinical leadership in the content of nursing education--a qualitative study of nursing students' experiences

OBJECTIVE

The aim of this study was to describe nursing students' experiences of clinical leadership during their last year of education.

BACKGROUND

Work as a nurse is complex with several demands from stakeholders who are colleagues, managers, patients and relatives. Therefore, it is important to provide students with tools for a forthcoming professional life as a nurse.

SETTING, PARTICIPANTS AND METHOD

A qualitative descriptive study was carried out in Jordan. Narratives (n=20) written by nursing students in their last year before graduation as a registered nurse were collected. The data were analysed by a manifest content analysis.

RESULTS

The results formed one category: (Clinical leadership-safety in being a nurse), and three subcategories (eye-opener, a role model and bridging the gap) described the students' clinical leadership experiences due to the preparation process for being a nurse. Clinical leadership applies theory to practice by using a holistic view in nursing.

CONCLUSION

Clinical leadership is a valuable tool for bridging the gap between theory and practice in nursing education. Skills within nursing management clarify and simplify nursing activities, which facilitates the transition from student to nurse. Focus on learning needs in nursing management is needed for stakeholders within education and health care organisations to facilitate graduation of well skilled nurses.

An improvement project within urological care

Purpose

– The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones.

Design/methodology/approach

– A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months.

Findings

– The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes.

Research limitations/implications

– This study includes one team (six members, different health professionals) within the same urology department.

Practical implications

– Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work.

Social implications

– Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work.

Originality/value

– Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

Need for Preparedness

Home health care faces challenges that could affect job satisfaction and quality of care. The aim of the study was to describe nurses’ experiences of competence in home health care. The study sample comprised of interviews with six nurses and was analyzed using manifest qualitative content analysis. The category “Being prepared” and subcategories “Importance of leadership strategies,” “Training promotes safety and independence,” and “Co-operation for professional development” were identified. Organizing and planning continuous learning activities at a managerial level, such as collaborations with a focus on supervision and sense of coherence (SOC) training, could develop patient safety within home health care. The results demonstrate that professionally competent nurses working in home health care environments contribute to safe working practices to meet quality care outcomes.

Elderly Men's Experience of Information Material about Melanoma-A Qualitative Study

Malignant melanoma is an aggressive disease that has been increasing worldwide. Public education is trying to focus on reducing intense sun exposure and raise awareness of signs and symptoms to prevent illness. The aim of the study was to describe and analyze elderly men's (over 65 years) experience of an information booklet regarding malignant melanoma. The study comprised of a total of 15 interviews with elderly men. The interviews were analyzed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. One category, Security-to act, and three subcategories, Availability-to use, Clarity-to understand, and Awareness-to know, were identified to describe the men's experiences of information material about melanoma. By using person-centered care, based on a holistic approach focusing on men's need for security to act on specific risk factors and to do skin self-examination, health could be improved. The results of this study could help other health organizations to develop information material to prevent illness, such as for skin self-examination. Strategies concerning educating, preparing, and training health professionals in interpersonal communication skills should be implemented in healthcare organizations to meet patients' information needs about illness to develop continuous learning and quality improvement.