The association between nurse managers' transformational leadership and quality of patient care: A systematic review

Nursing categories' perceptions of the practice environment and quality of care in North West Province: a cross-sectional survey design

BACKGROUND

There is a substantial amount of literature on the perception of the practice environment and quality of care as perceived by registered nurses and community services nurses in South Africa and worldwide, but there is little to no research that could be found regarding other categories of nurses, and how these perceptions differ between the different categories. Therefore, the aim of this study is to describe the different nursing categories' perceptions of the practice environment and quality of care and the association between the variables.

METHODS

This study applied a cross-sectional survey design. Data were collected in April 2021 in the public sector of the North West Province. Multiphase sampling was applied to all categories of nurses who worked in an in-patient unit in the selected hospital for at least 3 months (n = 236).

RESULTS

All nursing categories perceived the practice environment as negative, regarding nurse participation in hospital affairs; nurse manager ability, leadership, and support of nurses and staffing and resource adequacy. Perceived quality of care and patient safety items were perceived as neutral and good. However, in all instances, the perceptions of community service nurses and registered nurses were most negative, and enrolled nurse assistants most positive. Adverse events towards patients and nurses were perceived to only occur a few times a year. Overall, nurse perceptions of quality of care and patient safety were most correlated with the subscale of nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses. Adverse events towards patients were most correlated with the collegial nurse-physician relationship subscale, while adverse events towards nurses were correlated with the foundations of quality of care subscale.

CONCLUSION

Improving the practice environment, especially regarding the subscale nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses, is associated with improved quality of care. Nurses with higher qualifications, registered nurses and community service nurses rated quality of care lower than other categories of nurses, contributing to literature that higher qualified staff are more competent to assess the practice environment and quality of care.

Personal and organisational attributes that support transformational leadership in acute healthcare: scoping review

Objective Transformational leadership benefits both patients and staff. The objective of this scoping review was to explore personal and organisational attributes that support transformational leadership in acute health care. Methods A scoping review was undertaken using Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Medline Complete, PsycInfo and Emerald Insight databases. Search terms were related to transformational leadership and acute care hospitals. Results A total of 18 studies were included: 14 reported personal attributes and 8 reported organisational attributes supporting transformational leadership. The most common personal attributes were manager educational preparation (n  = 5), years of management experience (n  = 4), age (n  = 3) and emotional intelligence (n  = 3). The most common organisational attributes reported were larger organisational size (n  = 2) and culture (n  = 2). Personal (manager) attributes were synthesised into the following categories: demographics, role characteristics, leadership preparation and traits. Organisational attributes were categorised as manager support, organisational characteristics and organisational processes. Conclusions Despite the beneficial outcomes of transformational leadership for patients, staff and organisations, the personal and organisational attributes supporting transformation leadership are not well understood.

Relationship between transformational leadership, adverse patient events, and nurse-assessed quality of care in emergency units: The mediating role of work satisfaction

BACKGROUND

Effective leadership plays a pivotal role in healthcare settings, particularly in the fast-paced and high-pressure environment of the emergency room, as it is closely linked to patient safety and the overall quality of care. This study assessed the mediating role of work satisfaction in the relationship between nurses' perceptions of their nurse managers' transformational leadership, reported adverse patient events, and the nurse-assessed quality of care in the emergency units.

METHODS

A cross-sectional survey design was carried out involving 283 emergency room nurses from the Philippines, utilizing standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

RESULTS

Emergency room nurses perceived their nurse managers as highly transformational. Nurses' perceptions of transformational leadership in their nurse managers were associated with a reduction in reported adverse patient events and an increase in nurse-assessed nursing care quality. Work satisfaction partially mediated the relationship between transformational leadership and nurse-assessed nursing care quality, but it did not serve as a mediator between transformational leadership and reported adverse patient events.

CONCLUSION

The results suggested that enhancing transformational leadership behaviors among nurse leaders can foster work satisfaction in ER nurses, which, in effect, contributes to enhanced nursing quality of care provision in emergency settings.

Investigating the influence of selected leadership styles on patient safety and quality of care: a systematic review and meta-analysis

BACKGROUND

There is a popular belief that transformational leadership (TL) and servant leadership (SL) styles are influential in establishing a patient safety (PS) culture and improving the quality of care (QC). However, there are very few review articles investigating this phenomenon.

PURPOSE

This study performs a systematic review and meta-analysis to ascertain the influences of TL and SL on PS and QC.

METHODS

Published research work indexed in the two popular databases, that is, Scopus and PubMed, was selected based on the inclusion criteria. The systematic review was performed as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data such as country of publication, year, data type, research design, target population, sample size and conclusion were selected from the studies.

RESULTS

There are pieces of evidence suggesting a medium to strong effect of TL on PS. At the same time, the effect of TL on QC is not direct but indirect and is mediated through variables such as fostering positive organisational culture and enhancing organisational outcomes such as job satisfaction, leader effectiveness and willingness of nurses to spend some extra effort. A total of 27 studies were selected for final evaluation and 11 reported a relationship between TL and PS. The 'Fisher r-to-z transformed correlation coefficients' ranged from 0.3769 to 0.8673. Similarly, a total of four studies reported the relationship between TL and QC, 'Fisher r-to-z transformed correlation coefficients' ranged from 0.0802 to 0.5101, with most estimates being positive (80%).

CONCLUSION

TL has a strong and positive effect on PS but a positive and weak effect on the QC. There is not much evidence to establish SL's influence on PS and QC.