The impact of restricted decision‐making autonomy on health care managers’ health and work performance

Management Barriers to Inter-Organizational Collaboration in Preoperative Treatment of Patients with Hip or Knee Osteoarthritis

Inter-organizational collaboration among healthcare institutions is widely recognized to improve healthcare services. Because there is a research gap in examining the management barriers to inter-organizational collaboration in countries with less efficient healthcare systems and the reasons for non-implementation of innovations, the aim of this study was to identify key management barriers to inter-organizational collaboration in the preoperative treatment of patients with hip or knee osteoarthritis in Slovenia using a mixed-methods approach with key stakeholders. A cross-sectional study was conducted using multiple methods. An online survey (n = 135) and a multilevel qualitative approach were used, interviewing patients (n = 21), healthcare professionals, and other stakeholders (n = 42). The overall assessment of barriers affecting the integrated approach at the macro, meso, and micro levels revealed that macro-level factors were statistically significantly perceived as the major barriers, while micro-level factors were the minor barriers. There was no significant difference between public and private sector respondents in the barriers at the three levels. However, there were significant differences in the perceptions of different professional groups at the micro and meso levels, but not at the macro level. The analysis of the in-depth interviews confirmed the importance of macro-level barriers. A culture of noncooperation combined with "managerial indecision" prevails in the Slovenian healthcare system due to weak management support for inter-organizational collaboration, with managers and other key stakeholders failing to make urgent decisions due to a lack of autonomy. Interviewees commonly noted that one of the major barriers to inter-organizational collaboration was a lack of resources and staff, particularly of primary care physicians and nurses. In the preoperative treatment of patients with hip or knee osteoarthritis, the culture of non-collaboration and executive indecision are the major macro-level barriers to inter-organizational collaboration in Slovenia.

Nurse Managers' Involvement in Decision-Making and Associated Factors in Selected Government Hospitals, Addis Ababa, Ethiopia: A Cross-Sectional Study

Introduction

In the healthcare system, nurse managers' participation in decision-making was invaluable in preserving cost-effective service and safe patient care. Despite the fact that nurse managers have the power to ensure optimal health care service, their involvement in decision-making has not been well studied.

Objectives

To assess nurse managers' decision-making involvement and associated factors working in selected governmental hospitals in Addis Ababa, Ethiopia 2021.

Methods

A cross-sectional study was conducted among 176 nurse managers from government hospitals in Addis Ababa, with a response rate of 168 (95.5%). The total sample size is assigned in proportion. The technique of systematic random sampling was used. A structured, self-administered questionnaire was used to collect data, which was then checked, cleaned, entered into EPI Info version 7.2, and exported to SPSS software version 25 for analysis. In a binary logistic regression model analysis, a p-value < .25 was used as the cut-off point to consider variables as candidates for multivariable analysis. A p-value of .05 was used to determine the predictor variables with a 95% confidence interval.

Result

The mean age and standard deviation of the 168 respondents were 34.9 ± 4.1 years. More than half, 97 (57.7%), were excluded from general decision-making. Nurse managers in matron positions were 10 times more likely to participate in decision-making than head nurses (AOR = 10.00, 95% CI: 1.14-87.72, p = .038). Nurse managers who received managerial support were five times more likely to participate in good decision-making than nurse managers who did not receive managerial support (AOR = 5.29, 95% CI: 1.208-23.158, p = .027). Nurse managers who received feedback on their decision-making involvement had 7.7 times more good decision-making involvement than those who did not (AOR = 7.70, 95% CI: 2.482-23.911, p = .000).

Conclusion

According to the findings of the study, the majority of nurse managers were not involved in decision-making.

Development Work in Swedish Eldercare: Resources for Trustworthy, Integrated Managerial Work During the COVID-19 Pandemic

The extensive needs for developments of eldercare addressing working conditions, care quality, influence, and safety was highlighted during the pandemic. This mixed-method study contribute with knowledge about capability-strengthening development work and its importance for trustworthy managerial work, before and during the COVID-19 pandemic. Questionnaire data and narratives from first-line managers immediately before (n = 284) and 16 months into the pandemic (n = 189), structured interviews with development leaders (n = 25), and documents were analyzed. The results identify different focuses of development work. Strategic-level development leaders focused the strengthening of old adults' capabilities. While operational-level leaders approached strengthening employees' capability. First-line managers' rating of their trustworthy managerial work decreased during the pandemic and was associated with their workload, development support and capability-strengthening projects focusing employees' resources. The study demonstrates the gap between strategic and the operational levels regarding understanding of capability set and needed resources for strengthening capabilities and trustworthy, integrated managerial work regarding safety, influence, and quality conditions for old adults and employees.

'We just have to make it work': a qualitative study on assistant nurses' experiences of patient safety performance in home care services using forum play scenarios

OBJECTIVE

Safety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients' functioning and health. The aim of this study is to explore assistant nurses' adaptive responses to everyday work to ensure safe care in the home care context.

DESIGN

A qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis.

SETTING

Home care services organisations providing care to older people in their private homes in two municipalities in southern Sweden.

PARTICIPANTS

Purposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic.

RESULTS

Home care workers' adaptive responses to provide safe home care were driven by an ambition to 'make it work in the best interests of the person' by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people's independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity.

CONCLUSIONS

Safety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.

Managerial approaches for maintaining low levels of sick leave: A qualitative study

AIM

The aim of this study was to identify first line managers' approaches for maintaining low levels of sick leave among health care employees.

INTRODUCTION

One challenge in health care is the high level of sick leave among employees. High work demands and conflicting pressures characterize the work situation of both employees and first line managers, with potential negative effects on work-related health.

METHOD

First line managers at units with low and/or decreasing sick leave were interviewed. Thematic analysis was used to analyze the data.

RESULTS

The managers took a holistic approach in meeting their employees' broader needs and they were balancing high organizational demands through insubordination. To keep sick leave rate low, they created possibilities for the employees to influence their own working life through a present, visible and trustful leadership.

CONCLUSION

Managers responsible for units with low sick leave seemed to utilize a holistic approach with focus on their employees, and prioritized needs of their employees before organizational demands from top-management.

IMPLICATIONS FOR NURSING MANAGEMENT

First line managers in health care can have impact on sick leave among their employees and create good working conditions, despite pressure from their superiors.

Impact of knowledge sharing at work place on individual work performance of nurses in Pakistan

Purpose

The purpose of this study is to determine the impact of knowledge sharing (KS) at work place on the individual work performance (IWP) of nurses.

Design/methodology/approach

A cross-sectional quantitative approach based on a survey questionnaire was used to collect data from currently working 256 nurses in 6 general public sector hospitals of Lahore, Pakistan. Equal sized convenient sampling technique was used to select the sample from the intended population. Multiple regression was applied to test the research hypotheses.

Findings

The results indicated that the elements of IWP (task and contextual performance) were positively correlated with and influenced by two facets of KS (KS propensity and KS behavior). A cohesive sharing culture among nurses must be established at their respective work places to foster the delivery of quality care services and to improve their performance.

Practical implications

The study findings suggest that health-care institutes must consider the importance of KS to boost up the sharing culture among all levels (s) of employees by establishing an interconnected learning environment for improved work performance.

Originality/value

KS plays a vital role in the learning and development of employees by enhancing their work performance. The extant literature showed that there was a dearth of studies that determined the impact of KS at work place on the IWP of nurses. As KS has unique and challenging factors in Pakistan, therefore, the investigation of its impact on nurses’ work performance would be worthy.

Nurses' Autonomy and Perceived Barriers to Pain Management in Nursing Home Residents

Nurses' autonomy is essential for optimal pain management in nursing home (NH) residents. However, little is known about nurses' autonomy and how it relates to the issue of unrelieved pain in NH residents in Jordan and beyond. The current descriptive comparative study aimed to compare the prevalence of barriers to pain assessment and management in NH residents, perceived by nurses according to their autonomy level. Participating nurses were found to have low levels of clinical autonomy. A significant difference in the prevalence of perceived barriers to pain assessment and management was found among nurses according to their autonomy level. Findings provide a better understanding of nurses' autonomy and their perceived barriers to pain assessment and management in NH residents. Findings also highlight the significance of nurses' autonomy for the assessment and management of pain in NH residents. [Journal of Gerontological Nursing, 47(8), 45-52.].

Job Characteristics, Emotional Exhaustion, and Work-Family Conflict in Nurses

The purpose of this study is to identify whether emotional exhaustion, a component of burnout, mediates the relationship between job demands, job resources, and work-family conflict (WFC). A cross-sectional design was used with survey data. A total of 1,202 nurses in eastern Canada participated in this study. Data were collected via an online survey and analyzed using mediation analysis. The results indicated that job demands and emotional exhaustion predicted WFC. Moreover, emotional exhaustion partially mediated the relationship between job demands, supervisor support, and WFC. This model also showed that younger nurses had increased WFC. Our study indicates that there are several direct and indirect pathways leading to WFC. Moreover, workplace resources can reduce emotional exhaustion, which, in turn, may help maintain work-family balance in nurses. These findings contribute to the existing knowledge on the precursors and consequences of burnout symptoms.

Relationship Between Problematic Social Media Usage and Employee Depression: A Moderated Mediation Model of Mindfulness and Fear of COVID-19

Social media plays a significant role in modern life, but excessive use of it during the COVID-19 pandemic has become a source of concern. Supported by the conservation of resources theory, the current study extends the literature on problematic social media usage during COVID-19 by investigating its association with emotional and mental health outcomes. In a moderated mediation model, this study proposes that problematic social media use by workers during COVID-19 is linked to fear of COVID-19, which is further associated with depression. The current study tested trait mindfulness as an important personal resource that may be associated with reduced fear of COVID-19 despite problematic social media use. The study collected temporally separate data to avoid common method bias. Pakistani employees (N = 267) working in different organizations completed a series of survey questionnaires. The results supported the moderated mediation model, showing that problematic social media use during the current pandemic is linked to fear of COVID-19 and depression among employees. Furthermore, trait mindfulness was found to be an important buffer, reducing the negative indirect association between problematic social media use and depression through fear of COVID-19. These results offer implications for practitioners. The limitations of this study and future research directions are also discussed.