Love and Responsibility: A New Understanding of Leadership

Leading care close to the patient in community home care for older persons: A lifeworld hermeneutic study from nurses' perspectives

AIM

To explain and understand leading care close to older persons in community home care from the perspective of registered nurses (RNs).

BACKGROUND

Leading care close to older persons in home care is an overlooked and not well-described phenomenon. In home care, specific demands are placed on the registered nurse, as responsible for leading care guided by the older person's expectations and desires.

DESIGN

A reflective lifeworld hermeneutic approach grounded in the philosophy of phenomenology and hermeneutics. The study followed the COREQ checklist.

METHODS

Individual interviews were conducted with nine RNs working in community home care in a community in western Sweden. The data were analysed with a lifeworld hermeneutic approach.

RESULTS

The findings present four partially interpreted themes: leading with respect in a shared space, leadership that involves existential questions of life, balancing responsibility enables preservation of autonomy and challenges in maintaining a patient perspective. The partially interpreted themes conclude in a main interpretation: The patient perspective as an anchor when balancing responsibility for another person in an existential vulnerability of life.

CONCLUSION

Leading care means being both close to the patient and at a distance when caring is performed through the hands of others. Ethical demands are placed on RNs as they encounter the vulnerability of the older person.

RELEVANCE TO CLINICAL PRACTICE

The findings can contribute to a greater understanding of the meaning of RNs as leaders and may have an impact for decision makers and policies to create conditions for leadership that contributes to dignified care for older persons in community home care.

PATIENT OF PUBLIC CONTRIBUTION

Registered nurses working in community home care participated in data collection.

Undergraduate nursing student's attitudes to learning during clinical practice in different semesters when using a conceptual learning model grounded in a caritative caring perspective - A cross-sectional study

AIM

To describe undergraduate nursing students' attitudes to learning during clinical practice in different semesters when using the conceptual learning model, Model for Improvements in Learning Outcomes (MILO) grounded in a caritative caring perspective.

BACKGROUND

With the intention to support interlinking between theory and praxis and offer understanding and structure to facilitate learning, MILO, theoretically grounded in hermeneutics and a caritative caring perspective based on ethical values, was implemented. MILO consists of four contextual concepts (peer learning, co-clinical teachers, student-centred and student-active supervision) and four intrapersonal concepts (nursing, a reflective approach, a critical approach, quality and safety).

METHODS

A descriptive comparative quantitative study design was applied at a Swedish university, 3 hospitals and 13 municipalities in one county. Cross-sectional data collected via a questionnaire developed to assess attitudes to learning related to MILO's contextual and intrapersonal concepts and their applications were used.

RESULTS

209 students in semester 3, 4 and 6 participated in 6 different clinical practice courses. In comparison, intrapersonal concepts, that is, the student's own characteristics and abilities were viewed to be of greater value for learning than contextual, that is, organisational-related concepts in all semesters. Understanding the needs of others and reflective learning were rated to be of major importance. Students in semester 3 valued the use of the applications the highest. To be supervised in pairs was rated the lowest in semester 6. Some of the concepts and their applications were to great extent not applied.

CONCLUSIONS

In all semesters, fundamentals in caritative caring and characteristics and abilities related to the individual student were rated to be of greater importance for learning than environmental support. Providing students opportunities to develop independency seems essential. Use of a learning model such as MILO is dependent on a bearing of a caritative caring culture and a shared understanding between all involved in student learning during clinical practice.

Middle managers' ethos as an inner motive in developing a caring culture

BACKGROUND

Middle managers play a key role in promoting a caring culture in nursing homes. However, there is limited knowledge about middle managers' inner motives and their experiences of their responsibility in developing a caring culture.

RESEARCH AIM

The aim of the study is to get a deeper understanding of middle managers' motives and their experiences of their responsibility to develop a caring culture in nursing homes.

RESEARCH DESIGN

A qualitative design with a hermeneutic approach inspired by Gadamer was chosen which guided the interpretation of data. Qualitative semi-structured interviews were conducted.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected from thirteen middle managers in nursing homes, in six municipalities in northern Norway in September and October 2021.

ETHICAL CONSIDERATIONS

The study was approved by the Norwegian Centre for Research Data. Oral and written informed consent was obtained from participants.

FINDINGS

The findings show that the middle managers had non- egoistic motives to promote a caring culture as expressed in their attitudes and actions. They felt responsible to promote a caring culture where both patients and staff experienced care and were respected and recognized as unique individuals. Middle managers as good role models are responsible for being present and raising awareness of the importance of care in the nursing home culture by systematically reflecting on care values. However, a strong focus on the financial and administrative demands limits the middle managers' possibilities to promote a caring culture and prevented them from always acting as they wanted to act, which often causes moral distress.

CONCLUSION

Being in contact with inner motives, enables the leader to promote a homelike and caring culture where both patients and staff feels respected and recognized as unique individuals. This study highlights the importance of systematic reflection on caring values in nursing homes which leads to value awareness among all actors.

Ethical challenges and lack of ethical language in nurse leadership

Background:

In accordance with ethical guidelines for nurses, leaders for nurse services in general are responsible for facilitating professional development and ethical reflection and to use ethical guidelines as a management tool. Research describes a gap between employees’ and nurse leaders’ perceptions of priorities.

Objective:

The purpose of this article is to gain deeper insight into how nurses as leaders in somatic hospitals describe ethical challenges.

Design and method:

We conducted individual, quality interview with 10 nurse leaders, nine females and one male nurse aged 34–64 years. We used a hermeneutical approach to analyse the data.

Ethical considerations:

The participants received oral and written information about the study. Participation in the study was voluntary, and the participants were given the opportunity to withdraw. All of them gave written consent. The Norwegian Centre for Research Data approved the research project. In addition, the head of the hospitals gave permission to conduct our study.

Findings:

Four main areas were identified: deficient ethical language, conflicting demands on nurse leaders regarding staff management, concerns regarding young nurses’ ethical consciousness and restricting factors on the creation of a climate of ethics. The nurse leaders experienced considerable pressure. An unexpected finding was the lack of – and even disregard for – an ethical language.

Discussion and conclusion:

It is crucial to recognise ethics in all types of nursing approaches and to make it explicit. Ethical language must be implemented in nursing education. It must be recognised and used in clinical practice.

Recommendations:

We recommend further research be conducted into how nurses understand the concept of ethics and how to incorporate ethical principles into clinical nursing and nurse leadership.

Effect and Nursing Satisfaction of Bedside Nursing Combined with Detail Nursing in Clinical Nursing of Gastroenterology Department

Objective

The purpose of the study was to investigate the therapeutic effect and nursing satisfaction of bedside nursing combined with detail nursing in the gastroenterology department.

Methods

112 patients with gastrointestinal diseases admitted to our hospital from November 2018 to November 2019 were selected as the study subjects and randomly divided into a research group (n = 56) and reference group (n = 56). The reference group received routine clinical nursing, while on this basis, the research group received bedside nursing combined with detail nursing. After that, the clinical nursing effects of the two groups were compared.

Results

There were no significant differences in sex ratio, age, BMI, smoking history, drinking history, marital status, and disease types between the two groups (P > 0.05). The VAS scores in the two groups after intervention were significantly lower than those before intervention (P < 0.01), and the VAS scores in the research group after intervention were significantly lower than those in the reference group (P < 0.01). The nursing ability, nursing skills, and nursing responsibility in the research group were significantly higher than those in the reference group (P < 0.01). There were no significant differences between the two groups in the number of patients who were satisfied and needed improvement (P > 0.05). Besides, the number of very satisfied cases in the research group was significantly higher than that in the reference group (P < 0.05), and the number of unsatisfied cases was significantly lower than that in the reference group (P < 0.05). The total incidence of clinical adverse events in the research group was significantly lower than that in the reference group (P < 0.01). The gastrointestinal diseases related knowledge scores after intervention were significantly higher than those before intervention (P < 0.01), and the gastrointestinal diseases related knowledge scores after intervention in the research group were significantly higher than those in the reference group (P < 0.01). The GQOLI-74 scores after intervention in the two groups were significantly higher than those before intervention (P < 0.01), and the GQOLI-74 scores after intervention in the research group were significantly higher than those in the reference group (P < 0.01).

Conclusion

The application of bedside nursing mode combined with detail nursing in gastrointestinal diseases can effectively reduce patients' pains, as well as the incidence of clinical adverse events, and improve patients' life quality, with definite curative effect, which is worthy of promotion and application.

Relationships influencing caring in first-line nursing leadership: A visual hermeneutic study

AIM

To explore and interpret relationships that influence caring in nursing leadership, in the context of Nordic municipal health care, from first-line nurse managers' perspectives.

DESIGN AND METHOD

We chose a visual hermeneutic design. A three-stage interpretation process outlined by Drew and Guillemin, based on Rose, was used to analyse drawings and the following reflective dialogue from three focus groups, with a purposive sample of 11 first-line nurse managers. The study was conducted from February to May 2018.

RESULTS

The findings demonstrated that first-line nurse managers struggled to balance their vision with administrative demands. Caring for patients implied caring for staff; however, they often felt as if they were drowning in contradictory demands. First-line nurse management could be a lonely position, where the first-line nurse managers longed for belonging based on increased self-awareness of their position within an organisation. Superiors' support enabled first-line nurse managers' in their primary aim of caring for patients.

CONCLUSION

First-line nurse managers showed deep roots to their identities as nurses. Caring for patients included caring for staff and was their main concern, despite demanding reforms and demographic changes affecting leadership. Superiors' support was important for FLNMs' self-confidence and independence in leadership, so the first-line nurse managers can enact their vision of the best possible patient care. This study adds knowledge of the significance of caring in nursing leadership and the caritative leadership theory.

IMPACT

In order to recognise FLNMs as vulnerable human beings and provide individual confirmation and support, a caring organisational culture is needed. FLNMs need knowledge based on caring and nursing sciences, administration and participation in formal leadership networks. These findings can serve as a foundation for developing educational programmes for nurse leaders at several organisational levels.