Nurses' leadership in psychiatric care-A qualitative interview study of nurses' experience of leadership in an adult psychiatric inpatient care setting

Nursing department directors' perspectives on leadership training programme: A descriptive qualitative study

BACKGROUND

Leadership training is crucial for nurses to navigate changes, but research on nursing department directors' views of such programmes is limited.

AIM

To explore the perspectives and experiences of nursing department directors regarding a national leadership training programme for mid-level nurse managers.

DESIGN

Descriptive Qualitative Study.

SETTINGS

A national nurses association in Taiwan.

PARTICIPANTS

A purposive sample of 11 nursing department directors who recommended mid-level nurse managers for the programme.

METHODS

Eleven individual face-to-face interviews were conducted and analysed thematically between November 2022 and April 2023.

RESULTS

Three themes and eight subthemes emerged, including directors' strategies for identifying potential successors, providing coaching and guidance, and observing changes in trainees. Directors reported the programme broadened perspectives, fostered responsibility, and enhanced leadership skills in mid-level managers.

CONCLUSIONS

The engagement of nursing department directors and their adoption of a coaching style, such as fostering a growth mindset, were instrumental in the programme's success.

'I need support in becoming the leader I would like to be' - A qualitative descriptive study of nurses newly appointed to positions of leadership

AIM

The aim of the study was to understand the experiences of nurses who were newly appointed to a position of leadership including facilitators and barriers to success and what they considered important for the development of their role.

METHODS

We used a qualitative descriptive research design. The study was conducted in Norway with 10 nurses who had been appointed to a leadership position within the last 2 years. Participants were interviewed with individual qualitative interviews which were transcribed and subsequently analysed using thematic analysis.

RESULTS

The following four main themes were identified from the data: I feel lonely in the leadership position, I am not confident as a leader, I am unsure of the requirements and expectations of me, and I need support and supervision.

CONCLUSION

The results underscore the challenges reported by new leaders in nursing and their advocacy for mentorship as a facilitator for success. The qualifications of mentors were emphasised with a need for a comprehensive leadership skill set to address the multifaceted aspects of leadership development.

Solving the shortage of psychiatric - mental health nurses in acute inpatient care settings

INTRODUCTION

This debate essay proposes possible remedies to the shortage of nurses in acute inpatient mental health settings and draws inspiration from a Journal of Psychiatric and Mental Health Nursing editorial, Glascott and McKeown (2022, 29, 767).

AIM

The aim is to stimulate debate within the profession. The art and science of nursing continues to develop but staffing shortages in key areas undermine practice, leadership, academic and policy efforts to improve the quality of care for people attending services.

METHOD

This is a debate essay which draws on the authors' experience and presents ideas based on extant literature.

RESULTS

Organisational, professional and wider societal challenges are explored. Practice-based solutions as well as recommendations for improving the terms and conditions of employment of nurses are made. Opportunities which may empower the nursing profession are promulgated.

DISCUSSION

It is intended that this paper will provoke further discourse and may reflect the 'call to action' advocated by Glascott and McKeown (Journal of Psychiatric and Mental Health Nursing, 2022, 29, 767).

IMPLICATIONS FOR PRACTICE

While the focus is on acute inpatient mental health nursing, the ideas presented may have an application to wider nursing groups or a wider cadre of public sector workers.

Registered nurses' challenges and suggestions for improvement of their leadership close to older adults in municipal home healthcare

BACKGROUND

Worldwide people are living longer. The need for healthcare for older adults is increasing. The trend is towards advanced home healthcare, where registered nurses are key figures. This implies challenges for municipal home healthcare, as well as for registered nurses' leadership. The aim is to explore registered nurses' perceptions of challenges and suggestions for improvements in their leadership close to older adults in municipal home healthcare.

METHODS

The present study is part of a larger web-based questionnaire survey with a cross-sectional design. The design is inductive, analysing data using qualitative content analysis and descriptive statistics. A questionnaire with open-ended and closed-ended questions was used. A total of n = 70 registered nurses leading close to older adults participated in seven municipalities in two geographic areas in Sweden.

RESULTS

The results show registered nurses' perceptions of challenges as leaders close to older adults in terms of 11 categories. The categories are motivating for care, adjusting and coordinating nursing care to the older adult, relating to next of kin, managing communication difficulties, relating to social situations in the home, managing demands, working alone, having lack of time, collaborating with physicians, and care staff having low competence. The registered nurses suggested improvements for their leadership close to older adults in terms of nine categories. The categories are adjusting the work to the older adult, clarifying registered nurses' responsibility, balancing demands and resources, setting time aside, improving staffs' competence, ensuring staff's competence development, improving the work environment, and cooperation between professions in the municipality, as well as between healthcare organizations.

CONCLUSION

The results show that registered nurses' leadership in municipal home healthcare implies a wide range of challenges. There is a need for strategies to improve the organizational preconditions to reduce challenges in registered nurses' leadership in order to promote positive patient outcomes for safe and quality care.

Meaning Analysis and Alienation: A Method of Immanent Critique in Acute Psychiatry

In acute psychiatry, where people with severe mental disorders are frequently treated, there can be contradictions between concepts of illness among, e.g., patients and healthcare professionals, and also between medical and legal aspects. These contradictions do not manifest themselves openly but are immanent in the social practices of the treatment teams as contradictions between the social level and the individual level. They can lead to alienation, which may be reflected in poorer quality of treatment, such as the more frequent use of coercive measures or poorer adherence to therapy in patients. In the normal daily routine of a clinic, these contradictions are mostly hidden by hierarchical structures or by unbalanced concepts of psychiatric illness, or external critique is used to try to solve these contradictions. However, another way of dealing with these contradictions could be to analyze the potential and causes for alienation through systematic analysis and transformation of the whole system of a psychiatric ward to reduce the level of contradiction within it. The aim of this work is to use the concept of meaning elaborated by Luhmann to identify and recognize alienation potentials as concretely as possible and thus make them accessible to immanent critique. Meaning in Luhmann's use of the term serves to reduce complexity in a social context and always opens up consequential possibilities for action. Consequential limited possibilities at the level of action in a rigid social system (which psychiatric wards can be) can-at an individual level-lead to people subordinating themselves to the rigid system to an excessive degree and thus alienating themselves from the system. Thus, a rigid system with a narrowing of consequential possibilities excludes meaningful consequential possibilities. This leads to alienating contradictions and to possibilities of world appropriation being missed. The aim of the current analysis is not to make a general critique of psychiatry but to improve the theoretical basis to better understand the problem of alienation in acute psychiatry as a symptom of system-immanent contradictions and thus open up the possibility of transforming systems, e.g., psychiatric acute care units, by means of immanent critique.