Developing a decision-making dependency (DMD) model for nurse managers

Factors affecting decision making among nurse managers working in government hospitals

Background

Effective nursing management and leadership are essential for the provision of desired patient care that will contribute to the improvement of any country's health indicators. However, nurses' views and experiences on the multitude of personal and organizational factors which may impact their decision-making abilities are often neglected in the literature. The study aimed to assess magnitude of poor decision making and its associated factors among nurse managers in South Wollo Zone Governmental Hospitals, Amhara Regional State, Ethiopia, 2023.

Methods

Non experimental cross-sectional study was conducted among 168 nurse managers in South Wollo Zone Public Hospitals from April 01 2023 to May 15/2023. Participants were selected by using a simple random sampling technique. The data were collected by using structured questionnaire from the study participants. Data were entered using EPI data version 4.6 and exported to SPSS version 26 for analysis. The bi-variable logistic regression analysis model was used to identify the potential predictor variable, with p-value <0.25 was fitted into the multivariable logistic regression analysis model; p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare, factors associated with the outcome variable. The model fitness was checked by using the Hosmer and Lemeshow test. Data were presented with frequency tables, graphs, and pie charts.

Results

The study found that the overall magnitude of poor decision-making among nurse managers was 35.7%. Being self-confident [AOR = 0.01, 95% CI: (00.002, 0.05)], receiving feedback [AOR = 0.24, 95% CI: 0.08, 0.76], and getting managerial support [AOR = 0.22, 95% CI: (0.06, 0.81)] were negatively associated with poor decision-making among nurse managers.

Conclusion

Self-confidence, receiving feedback, and getting managerial support were variables significantly associated with poor decision-making. Authors strongly emphasize providing managerial support for nurse managers, increasing their habit of receiving feedback from colleagues, and encouraging them to build their self-confidence.

The effect of problem-solving and decision-making education on problem-solving and decision-making skills of nurse managers: A randomized controlled trial

OBJECTIVES

This study was conducted to determine the effect of an education program developed to improve the problem-solving and decision-making skills of nurse managers through both self- and subordinate evaluations and to compare it with a control group without training.

BACKGROUND

The most basic skill that managers should have is effective problem-solving and decision-making skills. Nevertheless, studies indicate that nurse managers' problem-solving and decision-making skills are at a moderate level and need to be improved.

DESIGN

Randomized controlled, pre-test-post-test, intervention and control group design. The study was conducted at a tertiary hospital in Istanbul, Türkiye. The sample consisted of 60 nurse managers (30 intervention and 30 control groups) and 300 nurses or nurse managers working as subordinates.

METHODS

After assessing the problem-solving and decision-making skills of nurse managers in the intervention and control groups by themselves and their subordinates, educational intervention was provided to the intervention-group. The problem-solving and decision-making education consists of two full days of interactive training based on case studies. Subsequent to the training, nurse managers in the intervention-group underwent a second follow-up. The third follow-up for the intervention-group, as well as the second follow-up for the control-group and all subordinates, were conducted in the third month after the training. Data were analysed using descriptive tests, independent sample t-test and dependent sample t-test for comparisons and repeated measures analysis of variance for the effectiveness of the training program.

RESULTS

Significant differences were found between the mean scores of the intervention-group nurse managers in problem-solving and decision-making pre and post-test (t=-11.005, p<.001) and case evaluations (t=-10.03, p<.001). Moreover, significant differences were identified in the assessment of pre-training, post-training and 3-month post-training average scores of overall problem-solving (F=93.643, p<.001) and rational (F=7.331, p=.007), dependent (F=13.607, p<.001), avoidant (F=11.543, p<.001) and spontaneous decision-making style (F=4.393, p<.001). When evaluated by the subordinates of the nurse managers in the intervention-group, there was a notable difference in the mean scores of overall problem-solving (t=-16.237, p=.001) and rational (t=-3.472, p=.001) and dependent decision-making styles (t=4.161, p=.001) before and 3-months after the training.

CONCLUSIONS

The study uncovered that the problem-solving and decision-making training provided to nurse managers led to enhancements in their respective abilities, a progression that was also noted by their subordinates. The findings underscore the significance of case-based training programs tailored to enhance the problem-solving and decision-making competencies of nurse managers.

Facilitating Utilization of Evidence-Informed Management by Nurse Managers in Healthcare Facilities: An Integrative Literature Review

Methods

An integrative review of the literature was conducted, including peer-reviewed articles published between 2010 and 2022. The databases used were BioMed Central, CINAHL Complete, MEDLINE Complete, PubMed (via EBSCOhost), the Complimentary Index (Taylor and Francis, Elsevier, Wiley, and Springer), Sabinet, ScienceDirect, and Scopus, followed by a manual search using Google Scholar and a citation search. Johns Hopkins Nursing Evidence-based Practice Research and non-Research evidence tools were used for appraisal. Thematic analysis was used to synthesize the extracted data.

Results

Based on thirteen determinants influencing nurse managers' utilization of evidence-informed management practices, three themes were identified from a total of thirteen relevant studies: (1) Nurse manager determinants in utilization of evidence-informed management (Microlevel); (2) Organizational determinants in utilization of evidence-informed management (Mesolevel); (3) External stakeholders and context determinants of utilization of evidence-informed management practices (Macrolevel).

Conclusion

The themes were found to be interconnected and interdependent, facilitating the effective utilization of evidence-informed management by nurse managers at micro-, meso-, and macrolevels, but highlight the need for strengthening health systems and support. Future studies are required to provide a more comprehensive understanding of the determinants influencing nurse managers' utilization of evidence-informed management practices. Implications for Nursing Management. For nurse managers to optimally utilize evidence-informed management, executive management and policymakers require to provide resources and support such as continuous education, incentives, effective communication, funding structures, and ownership.

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.

Cultural competence and decision-making of nurse leaders in a university hospital in Saudi Arabia: A descriptive-correlation study

AIMS

To determine the quality of decision-making and cultural competence in terms of cultural competence behavior and cultural awareness and sensitivity of nurse leaders. Furthermore, this study explores the relationships between selected demographic profiles, cultural awareness and sensitivity, cultural competence behavior, and quality of decision-making.

BACKGROUND

Diversity contributes to varying beliefs and practices in the workplace. Leaders with cultural competence, awareness, and sensitivity can evaluate alternatives for the decision-making process and develop effective strategies to implement decisions.

METHODS

A descriptive correlational design was utilized. The respondents (n=122) completed the Cultural Competence Assessment instrument and Decision Making Quality Scale questionnaire.

RESULTS

Cultural awareness and sensitivity are significantly related to the Middle Eastern race. Furthermore, cultural competence behavior is significantly related to years of experience in Saudi Arabia and leadership positions. Quality of decision-making is significantly related to years of experience in Saudi Arabia. Cultural awareness, sensitivity, and cultural competence behavior are significantly related to the quality of decision-making.

CONCLUSIONS

Culturally aware, sensitive, and competent nurse leaders are more likely to adhere to the quality decision-making criteria.

IMPLICATIONS FOR NURSING MANAGEMENT

Promoting training and continuing education for nurse leaders are crucial to ensure they possess the right cultural knowledge and skills.

Moving and Handling Children After Death: An Inductive Thematic Analysis of the Factors That Influence Decision Making by Children's Hospice Staff

Hospices for children and adolescents in the United Kingdom provide care to the bodies of deceased children in specially designed chilled bedrooms called "cool rooms." In an effort to develop resources to support hospice practitioners to provide this specialist area of care, this study aimed to identify the factors that influence decision making when moving and handling children's bodies after death in a hospice cool bedroom. An internet-based survey was sent to all practitioners employed by 1 children's hospice. A total of 94.9% of eligible staff responded (n = 56). An inductive approach to thematic analysis was undertaken, using a 6-phase methodological framework. Three core themes were identified that inform practitioners' perception of the appropriateness of moving and handling decisions: care of the body, stages of care, and method of handling. The complexity of decision making and variation in practice was identified. Practitioners relied on both analytical and initiative decision making, with more experienced practitioners using an intuitive approach. Evidence-based policy and training influence the perception of appropriateness and the decisions and behavior of practitioners. The development of a policy and education framework would support practitioners in caring for children's bodies after death, standardizing expectations and measures of competence in relation to moving and handling tasks.

Leadership competencies of first-line nurse managers: a quantitative study

PURPOSE

This paper aims to examine the leadership competencies of first-line nurse managers (FLNMs) at the unit level in the eastern region of Ghana.

DESIGN/METHODOLOGY/APPROACH

The paper is a quantitative cross-section design.

FINDINGS

Nurse managers exhibited a moderate level of knowledge and ability to apply leadership competencies. Gender, rank, qualification, professional experience, management experience and management training jointly predicted the leadership competencies of FLNMs [(R² = 0.158, p = 0.016]. However, only management training was a significant predictor in the model.

PRACTICAL IMPLICATIONS

Inappropriate leadership competencies have severe consequences for patients and staff outcomes. This situation necessitates a call for a well-structured program for the appointment of FLNMs based on competencies.

ORIGINALITY/VALUE

This study is the first in Ghana which we are aware of that examined the leadership competencies at the unit level that identifies predictors of leadership competencies.