Characteristics of highly rated leadership in nursing homes using item response theory

Understanding Adaptive Leadership in the Context of Nursing Homes

Rapidly growing populations of older adults rely heavily on formal long-term care services such as those provided in nursing homes. Nursing home staff are confronted with complex challenges. We explored how staff (N = 88), particularly care aides, interpreted challenges and responded to them by taking adaptive leadership roles, and engaging in technical and adaptive work in nursing homes. We conducted analysis of the ethnographic case studies. In long-term care settings, staff face complex challenges in improving resident care due to contextual barriers. These include demanding work conditions and inadequate resources. Additionally, top-down communications, despite being well-intentioned, often lead to misinterpretation and a lack of staff motivation. Nonetheless, we found that certain staff managed to overcome these contextual barriers and effectively execute change initiatives by assuming adaptive leadership roles. Formal leaders have a vital role in empowering staff, including care aides, and facilitating their adaptive leadership behaviors.

Addressing the workforce crisis in (rural) social care: A scoping review

BACKGROUND

This scoping review identifies strategies potentially addressing the 'workforce crisis' in rural social care. The increasing global demand for social care has been coupled with widely recognised challenges in recruiting and retaining sufficient staff to provide this care. While the social care workforce crisis is a global phenomenon, it is particularly acute in rural areas.

METHODS

The review identified 75 papers which (i) had been published since 2017, (ii) were peer reviewed, (iii) concerned social care, (iv) were relevant to rural settings, (v) referenced workforce shortages, and (vi) made recommendations for ways to address those shortages. Thematic synthesis was used to derive three analytical themes with a combined 17 sub-themes applying to recommended strategies and evidence supporting those strategies.

RESULTS

The most common strategies for addressing social care workforce shortages were to improve recruitment and retention ('recruit and retain') processes without materially changing the workforce composition or service models. Further strategies involved 'revitalising' the social care workforce through redeploying existing staff or identifying new sources of labour. A small number of strategies involved 're-thinking' social care service models more fundamentally. Very few papers specifically considered how these strategies might apply to rural contexts, and evidence for the effectiveness of strategies was sparse.

CONCLUSION

The review identifies a significant gap in the literature in relation to workforce innovation and placed-based studies in rural social care systems. It is unlikely that the social care workforce crisis can be addressed through continuing attempts to recruit and retain workers within existing service models.

Exploring the impact of nursing home managers' leadership on staff job satisfaction, health and intention to leave in nursing homes

AIMS AND OBJECTIVES

To explore the impact of nursing home leadership and staffing characteristics on staff job satisfaction, health and intention to leave.

BACKGROUND

The number of older people has outpaced growth in the nursing home workforce worldwide. Identifying predictors with the potential to positively impact staff job satisfaction, health and intentions to leave are important. Leadership of the nursing home manager can be one such predictor.

DESIGN

Cross-sectional design.

METHODS

A sample of 2985 direct care staff in 190 nursing homes in 43 randomly selected municipalities in Sweden completed surveys on leadership, job satisfaction, self-rated health and intention to leave (response rate 52%). Descriptive statistics and Generalised Estimating Equations were conducted. The STROBE reporting checklist was applied.

RESULTS

Nursing home managers' leadership was positively related to job satisfaction, self-rated health and low intention to leave. Lower staff educational levels were related to poorer health and lower job satisfaction.

CONCLUSIONS

Nursing home leadership plays a significant role in the job satisfaction, self-reported health and intention to leave of direct care staff. Low education levels among staff seem to negatively influence staff health and job satisfaction, suggesting that educational initiatives for less-educated staff could be beneficial for improving staff health and job satisfaction.

RELEVANCE TO CLINICAL PRACTICE

Managers seeking to improve staff job satisfaction can consider how they support, coach and provide feedback. Recognising staff achievement at work can contribute to high job satisfaction. One important implication for managers is to offer continuing education to staff with lower or no education, given the large amount of uneducated direct care workers in aged care and the impact this may have on staff job satisfaction and health.

NO PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was required to outcome measures in this study. Direct care staff and managers contributed with data.

Longitudinal changes in nursing home leadership, direct care staff job strain and social support in Swedish nursing homes-findings from the U-AGE SWENIS study

BACKGROUND

Promoting healthy work environment as a manager in nursing homes is important to safeguard staff health and well-being as well as care quality when facing increasing demands. The impact of leadership on staff work environment needs further exploration.

OBJECTIVES

To describe longitudinal changes in nursing home leadership, direct care staff characteristics, job strain and social support.

METHODS

This study has a repeated cross-sectional design, a five-year follow-up study. Nursing home staff in 181 corresponding units (n = 1253 in 2014 and n = 1176 in 2019) completed surveys about leadership, staff job strain and social support in a five-year follow-up study. Descriptive and regression analyses were conducted.

RESULTS

A higher degree of leadership defined by coaching and providing direct feedback to care staff, handling conflicts in a constructive way and having control of the clinical work, was significantly associated with a lower degree of job strain and a higher degree of social support among staff, with stronger associations at follow-up. The proportion of enrolled nurses increased significantly at follow-up.

CONCLUSIONS

Leadership is increasingly important for staff work environment, especially in times of increased workload and decreasing collegiality and deteriorating work atmosphere at work.

IMPLICATIONS FOR PRACTICE

Stakeholder and policy makers in nursing home care may reflect on how managers' leadership is prioritised in these environments because such leadership is associated with staff job strain and social support. Managers striving to improve the work situation of staff may consider their own role and allow flexibility in how and when the work can be performed.

The Making of Nurse Leaders in the Nursing Home

Nurse leaders are first and foremost, registered nurses. Nursing leadership is critical for improving the care and quality of life for older adults. Visionary nurse leaders collaborate, motivate, influence, and inspire the achievement of values and goals to improve the quality of life for older adults in long-term care. Professional registered nurses are transformational servant nurse leaders who hold the key to nursing home reform.

Leadership challenges and strategies to dementia care in Chinese faith-based nursing homes: A qualitative study

AIM

To address the need and fill a knowledge gap in understanding challenges and coping strategies from the perspectives of nursing home leadership.

BACKGROUND

The rapid increase of older adults with dementia in China highlights the need for research on dementia care in long-term care facilities.

METHODS

Semi-structured interviews were conducted among 20 facility directors employed by faith-based nursing homes across 12 provinces in China via phone or in-person in their native language. Two researchers fluent in Mandarin Chinese and English coded interview transcripts; thematic analysis was conducted to identify patterns.

RESULTS

Four primary challenges were identified, including recruiting and retaining nursing staff, funding, lacking governmental support, and discord with family members. The coping strategies included using external resources, incorporating religious beliefs, teamwork, rewarding performance, and improving staff skills and empathy.

CONCLUSIONS

This study contributes to nursing home practice knowledge by disseminating insights of administrators regarding culturally relevant dementia management strategies in China.

IMPLICATIONS FOR NURSING MANAGEMENT

Teamwork and staff encouragement Advocate for a sustainable governmental financial support Staff training and staff-resident ratio regulations and policy Seeking external resources Integrate faith-based means for problem management and service quality improvement.

Technology-based interventions for nursing home residents: a systematic review protocol

INTRODUCTION

A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19.

METHODS AND ANALYSIS

Databases including the PubMed, PsycINFO, CINAHL and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between 1 January 2010 to 30 September 2021. Titles, abstracts and full-text papers will be reviewed against the eligibility criteria. The Cochrane Collaboration evaluation framework will be adopted to examine the risk of bias of the included study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process and implications for existing interventions and research evaluated by a multidisciplinary research team.

ETHICS AND DISSEMINATION

As the study is a protocol for a systematic review, ethical approval is not required. The study findings will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

CRD 42020191880.

The influence of nursing home managers' leadership on person-centred care and stress of conscience: A cross-sectional study

Background

Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience.

Methods

This study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations.

Results

Leadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders.

Conclusion

Nursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.

Characteristics of nursing home units with high versus low levels of person-centred care in relation to leadership, staff- resident- and facility factors: findings from SWENIS, a cross-sectional study in Sweden

BACKGROUND

The context of care consists of factors that determines the extent to which staff can offer person-centred care. However, few studies have investigated factors that can explain variation in levels of person-centred care among nursing home units. The aim of this study was to explore factors characterizing nursing home units with high and low degree of person-centred care, with focus on leadership, staff, resident and facility factors.

METHODS

Cross-sectional data from residents, staff, and managers in 172 randomly selected nursing homes in Sweden were collected in 2014. Activities of Daily Living Index, Gottfries' cognitive scale, Person-centred Care Assessment Tool together with demographic information and estimations of leadership engagement was used. Independent samples t-test and Chi2 test were conducted.

RESULTS

Highly person-centred units were characterised by leaders engaging in staff knowledge, professional development, team support and care quality. In highly person-centred units' staff also received supervision of a nurse to a larger extent. Highly person-centred units were also characterised as dementia specific units, units with fewer beds and with a larger proportion of enrolled nurses. No differences in degree of person-centred care were seen between public or private providers.

CONCLUSIONS

This study provides guidance for practitioners when designing, developing and adapting person-centred units in aged care contexts. Managers and leaders have an important role to promote the movement towards a person-centred practice of care, by supporting their staff in daily care, and engaging in staff knowledge and professional development. Targeting and adjusting environmental factors, such as provide small and dementia adapted environments to match the residents' personal preferences and capacity are also important when striving towards person-centredness.

The significance of nursing home managers' leadership-longitudinal changes, characteristics and qualifications for perceived leadership, person-centredness and climate

AIMS AND OBJECTIVES

The aim was to explore changes in nursing home managers' leadership, person-centred care and psychosocial climate comparing matched units in a five-year follow-up and to explore the significance of managers' educational qualifications and the ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate in the follow-up data.

BACKGROUND

Leadership has been described as crucial for person-centred care and psychosocial climate even though longitudinal data are lacking. The significance of managerial leadership, its characteristics, managerial qualifications and ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate also needs further exploration.

DESIGN

Repeated cross-sectional study.

METHODS

This study used valid and reliable measures of leadership, person-centred care, psychosocial climate and demographic variables collected from managers and staff n = 3605 in 2014 and n = 2985 in 2019. Descriptive and regression analyses were used. The STROBE checklist was used in reporting this study.

RESULTS

Leadership was still positively significantly associated to person-centred care in a five-year follow-up, but no changes in strength were seen. Leadership was still positively significantly associated with psychosocial climate, with stronger associations at follow-up. Six leadership characteristics increased over time. It was also shown that a targeted education for nursing home managers was positively associated with person-centred care.

CONCLUSIONS

Leadership is still pivotal for person-centred care and psychosocial climate. Knowledge of nursing home managers' leadership, characteristics and educational qualifications of significance for person-centred delivery provides important insights when striving to improve such services.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used for management and clinical practice development initiatives because it was shown that nursing home managers' leadership is vital to person-centred care practices and improves the climate for both staff and residents in these environments.

The introduction of care robots as a leadership challenge in home care facilities in Finland

Aims

This paper analyses the factors that influence home care employees’ intention to introduce robots.

Background

The introduction of different kinds of care robots is a topical issue in elderly care now and in the near future.

Methods

Cross‐sectional research conducted through a questionnaire. The survey data (N = 162) were collected in five locations around Finland in 2019. The analysis was carried out by regression analysis, Sobel test and by Hayes’ bootstrapping method.

Results

The results show that self‐efficacy is pivotal in the willingness to introduce care robots. Employees’ age increases the enthusiasm to introduce robots but reduces self‐efficacy. Work engagement does not correlate with self‐efficacy or behavioural intention related to the introduction of care robots.

Conclusions

The present paper reveals the significance of attitudes, cognitive factors and age in the adoption of care robots in home care facilities.

Practical implications

It is important to pay attention to supporting the employees’ sense of technology management and the construction of a robot‐positive atmosphere when introducing care robots, and the development of skills of older employees and employees with a lower educational level should be supported.

Understanding good leadership in the context of English care home inspection reports

PURPOSE

As part of their inspection of care homes in England, the statutory inspector (the Care Quality Commission [CQC]) makes a judgement on the quality of the home's leadership. Their view is critical as it is intended to inform consumer choice and because the statutory nature of inspection means these views hold considerable authority. The purpose of this paper is to look at the content of a selection of reports and seek to determine what the CQC understands by the concept of "good leadership".

DESIGN/METHODOLOGY/APPROACH

A purposive sample of recent CQC inspection reports was selected and subjected to a qualitative content analysis. Inspections are structured around five main questions. The resulting themes describe areas of focus within the section of reports that feature the question "Are they well-led?".

FINDINGS

Inspection reports were found to focus on four main themes: safety and quality of care; day-to-day management of staff; governance and training in the home; and integration and partnership working. In the discussion section, the authors reflect on these themes and suggest that the CQC's view of leadership is rather limited. In particular, while an emphasis is placed within the literature and policy on the importance of leadership in delivering change and quality improvement, little attention is paid to this within the leadership section of inspection reports.

RESEARCH LIMITATIONS/IMPLICATIONS

The authors' research is based on a small-scale sample of inspection reports; nevertheless, it suggests a number of avenues for further research into the way in which leadership and management capabilities are developed and monitored in the sector.

ORIGINALITY/VALUE

The analysis in this report offers a view of how the inspection regime implements its own guidance and how it assesses leadership. The reports, as public-facing documents, are artefacts of the inspection regime and critical not just as evidence of the practice of inspection but as influence on care home operations and the choices of care home residents and their families.

Residential aged care leadership in Australia-Time for a compassionate approach: A qualitative analysis of key leader skills and attributes

AIMS

To examine the perceptions of leadership by leaders within residential aged care and to identify the crucial requirements for successful leadership in this complex industry.

BACKGROUND

As an industry capitalizing on the concept of 'care', one of the critical attributes this research has found to be absent in many aged care leadership approaches is compassion.

METHODS

A qualitative methodology using thematic analysis was used to explore the construction of leadership attributes needed within residential aged care, as perceived by leaders in these organisations.

RESULTS

Senior staff in the aged care industry believe that compassion is both a key component and a gap in the skill set of aged care leadership and leaders. While most studies define good leadership and care in relation to clinical 'safety' and 'efficiency', this research demonstrates that compassionate caring is central to high-quality care in residential aged care.

CONCLUSIONS

The aged care industry needs to enhance and encourage compassionate leadership as a cornerstone of humane and dignified care.

IMPLICATIONS FOR NURSING

When developing theoretical explanations for the role of leadership in aged care, researchers should contemplate compassion as a key attribute required in residential aged care leaders. Education and training in this industry must incorporate the attributes associated with compassion, including emotional intelligence and person-centred leadership.

Factors associated with staff-to-resident abuse in Norwegian nursing homes: a cross-sectional exploratory study

BACKGROUND

Elder abuse is a public health problem that is gaining attention due to its serious impacts on people's health and well-being, and it is predicted to increase along with the world's rapidly ageing population. Staff-to-resident abuse in nursing homes is a complex and multifaceted phenomenon associated with multiple factors on different levels of the ecological model. This study aimed to explore individual, relational, and institutional characteristics associated with perpetrated staff-to-resident abuse in nursing homes, using a multilevel hierarchical approach.

METHODS

This was a cross-sectional exploratory study of 3693 nursing staff (response rate 60.1%) in 100 randomly selected nursing homes in Norway. We explored the characteristics of nursing staff, their relationship with residents, and institutional features associated with three types of abuse: psychological abuse, physical abuse, and neglect. These were modelled using multilevel mixed-effects logistic regression analyses.

RESULTS

Individual staff factors found to be associated with all three types of abuse were 1) being a registered nurse/social educator (OR 1.77-2.49) or licensed practical nurse (OR 1.64-1.92), 2) reporting symptoms of psychological distress (OR 1.44-1.46), 3) intention to leave the job (OR 1.35-1.40), and 4) reporting poor attitudes towards people with dementia (OR 1.02-1.15). Also, staff who reported poorer quality of childhood were more likely to perpetrate neglect (OR 1.14). Relational factors such as care-related conflicts (OR 1.97-2.33) and resident aggression (OR 1.36-2.09) were associated with all three types of abuse. Of institutional factors, lack of support from a manager was associated with perpetrating psychological abuse (OR 1.56).

CONCLUSIONS

We found several predictors of staff-to-resident abuse on different levels of the ecological model, which underlines the importance of using a multifaceted approach to identify risk factors of elder abuse in nursing homes. However, future studies should explore the underlying mechanism and causes with a prospective or qualitative design and target the multifaceted nature of risk factors when designing preventive interventions.

Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol

Background

A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19.

Methods

Databases including PubMed, PsycINFO, CINAHL, and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between January 1st, 2010 to December 4th, 2020. Titles, abstracts, and full-texts papers will be reviewed against the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process, and implications for existing interventions and research evaluated by a multidisciplinary research team.

Results

NA-protocol study.

Conclusions

Our study will fill critical gaps in the literature by providing a review of technology-based interventions tested in the nursing home setting. As the older adult population grows, there is an urgent need to identify effective technology-based interventions that can address the distinctive characteristics and preferences of nursing home residents. Clear and comprehensive understanding of how available technology-based health solutions facilitate healthcare for nursing home residents will shed light on the approaches open to residents to fend off the negative health consequences amid and beyond the influence of COVID-19.

Systematic Review Registrations

PROSPERO CRD 42020191880.

Leadership styles and leadership outcomes in nursing homes: a cross-sectional analysis

Background

Although leadership is considered as a key factor in health care, leadership styles and outcomes in nursing homes often remain a black box. Therefore, this study explored leadership styles and leadership outcomes of head nurses and directors of nursing (DoN) in nursing homes based on well-defined leadership concepts.

Methods

A multicenter cross-sectional analysis was conducted on baseline data of an ongoing cohort study comprising a convenience sample of nursing home staff (n = 302). Leadership styles and leadership outcomes of head nurses and DoN were measured through the rater form of the Multifactor Leadership Questionnaire 5X (MLQ-5X). Based on the Full Range of Leadership Model, the MLQ-5X visualizes transformational (relation and change focused), transactional (task-focused) and passive-avoidant (absence of leadership) leadership styles. Scores of head nurses and DoN for leadership styles and outcomes were compared with European Reference Scores (ERS) using two-sided one-sample t-tests.

Results

Compared with ERS, head nurses and DoN scored significantly lower (p < 0.001) on transformational and transactional leadership styles and significantly higher (p < 0.001) on passive-avoidant leadership styles. All leadership outcomes were significantly lower (p < 0.001) for head nurses. Similar results, however not statistically significant, were found concerning leadership outcomes of DoN.

Conclusions

Results indicate that passive-avoidant leadership styles are excessively present in contrast to transformational leadership styles in nursing homes. This highlights an urgent need to invest in leadership development. Therefore, future research should focus on interventions for the development of transformational leadership.

Challenges and opportunities for the multicultural aged care workforce: A systematic review and meta-synthesis

AIMS

To identify (a) the challenges for multicultural aged care teams; (b) the opportunities to facilitate teamwork; and (c) the strategies to assist team members in a multicultural work environment.

BACKGROUND

High-income countries have an increasingly culturally diverse aged care workforce. Fostering teamwork in such an environment is challenging.

METHODS

This systematic review of qualitative studies followed the Joanna Briggs Institute (JBI) meta-aggregation approach. Six databases were searched. Retrieved articles were screened by two reviewers. This review identified 111 findings that were aggregated into 15 categories and five themes.

FINDINGS

Aged care workers' awareness of cultural diversity varies, and their knowledge of each other's cultural background is limited. However, cultural skills are demonstrated, contributing to teamwork. Their experience in cross-cultural encounters is broad, and enhanced team cohesion is desired.

CONCLUSIONS

The cultural competence of the aged care workforce shapes team building, peer support opportunities and positive cross-cultural experiences.

IMPLICATIONS FOR NURSING MANAGEMENT

Recommendations are provided for the adaptation of aged care workers to culturally diverse teams, fostering teamwork to enhance care outcomes for clients. Interventions for improvements in cross-cultural leadership and management, and staff experience of cross-cultural encounters are much needed.

Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol

Background: A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19. Methods: Databases including PubMed, PsycINFO, CINAHL, and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between January 1 st , 2020 to July 7 th , 2020. Titles, abstracts, and full-texts papers will be reviewed against the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process, and implications for existing interventions and research evaluated by a multidisciplinary research team. Results: NAâ€"protocol study Conclusions: Our study will fill critical gaps in the literature by providing a review of technology-based interventions tested in the nursing home setting. As the older adult population grows, there is an urgent need to identify effective technology-based interventions that can address the distinctive characteristics and preferences of nursing home residents. Clear and comprehensive understanding of how available technology-based health solutions facilitate healthcare for nursing home residents will shed light on the approaches open to residents to fend off the negative health consequences amid and beyond the influence of COVID-19. Systematic Review Registrations: PROSPERO CRD 42020191880.

Authentic leadership and job satisfaction among long-term care nurses

Purpose

The purpose of this study is to examine the effects of managers’ authentic leadership, person–job match in the six areas of worklife (AWLs) and emotional exhaustion on long-term care registered nurses’ job satisfaction.

Design/methodology/approach

A secondary analysis of baseline data from a national survey of 1,410 Canadian registered nurses from various work settings was used in this study, which yielded a subsample of 78 nurses working in direct care roles in long-term care settings. Hayes’ PROCESS macro for mediation analysis in SPSS was used to test the hypothesized model.

Findings

Findings showed that authentic leadership significantly predicted job satisfaction directly and indirectly through AWLs and emotional exhaustion.

Practical implications

Authentic leadership may provide guidance to long-term care managers about promoting nurses’ job satisfaction, which is essential to recruiting and retaining nurses to meet the care needs of an aging population.

Originality/value

As demand for care of the aged is increasing and creating challenges to ensuring a sufficient and sustainable nursing workforce, it is important to understand factors that promote long-term care nurses’ job satisfaction. Findings contribute to knowledge of long-term care nurses by suggesting that managers’ authentic leadership can positively affect nurses’ job satisfaction directly and indirectly through positive perceptions of AWLs and lower emotional exhaustion.

Exploring a Common Data Element for International Research in Long-Term Care Homes: A Measure for Evaluating Nursing Supervisor Effectiveness

The aim of this study is to recommend a common data element (CDE) to measure supervisory effectiveness of staff working in LTC homes that can be used in international research. Supervisory effectiveness can serve as a CDE in an effort to establish an international, person-centered LTC research infrastructure in accordance with the aims of the WE-THRIVE group (Worldwide Elements to Harmonize Research in Long Term Care Living Environments). A literature review was completed and then a panel of experts independently reviewed and prioritized appropriateness of the measures with mindfulness of their potential applications to international LTC settings. The selection of a recommended CDE measure was guided by the WE-THRIVE group's focus on capacity rather than deficits, the expected availability of internationally comparable data and the goal to provide a short, ecologically viable measurement, specifically for low- and middle-income countries. Two measures were considered as the CDE for supervisory effectiveness, Benjamin Rose Relationship Scale and the Supervisory Support Scale; however, given that the latter measure has been translated in Spanish and Chinese and has been tested with nursing assistants in both of these countries with good psychometric properties, our group recommends it as the CDE going forward.

Embodying person-centred being and doing: Leading towards person-centred care in nursing homes as narrated by managers

AIMS AND OBJECTIVES

To explore how managers describe leading towards person-centred care in Swedish nursing homes.

BACKGROUND

Although a growing body of research knowledge exists highlighting the importance of leadership to promote person-centred care, studies focused on nursing home managers' own descriptions of leading their staff towards providing person-centred care is lacking.

DESIGN

Descriptive interview study. COREQ guidelines have been applied.

METHODS

The study consisted of semi-structured interviews with 12 nursing home managers within 11 highly person-centred nursing homes purposively selected from a nationwide survey of nursing homes in Sweden. Data collection was performed in April 2017, and the data were analysed using content analysis.

RESULTS

Leading towards person-centred care involved a main category; embodying person-centred being and doing, with four related categories: operationalising person-centred objectives; promoting a person-centred atmosphere; maximising person-centred team potential; and optimising person-centred support structures.

CONCLUSIONS

The findings revealed that leading towards person-centred care was described as having a personal understanding of the PCC concept and how to translate it into practice, and maximising the potential of and providing support to care staff, within a trustful and innovative work place. The findings also describe how managers co-ordinate several aspects of care simultaneously, such as facilitating, evaluating and refining the translation of person-centred philosophy into synchronised care actions.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used to inspire nursing home leaders' practices and may serve as a framework for implementing person-centred care within facilities. A reasonable implication of these findings is that if organisations are committed to person-centred care provision, care may need to be organised in a way that enables managers to be present on the units, to enact these strategies and lead person-centred care.

The context of care matters: Older people's existential loneliness from the perspective of healthcare professionals-A multiple case study

AIM

To explore existential loneliness among older people in different healthcare contexts from the perspective of healthcare professionals.

BACKGROUND

Professionals meet and care for older people in most care contexts and need to be prepared to address physical, psychological, social and existential needs. Addressing existential loneliness can be both challenging and meaningful for professionals and is often not prioritised in times of austerity.

DESIGN

A multiple case study design was used.

METHODS

Focus group interviews were conducted with healthcare professionals (n = 52) in home, residential, hospital and palliative care settings. The analysis was performed in two steps: firstly, a within-case analysis of each context was conducted, followed by a cross-case analysis.

FINDINGS

Differences and similarities were observed among the care contexts, including for the origin of existential loneliness. In home care and residential care, the focus was on life, the present and the past, compared to hospital and palliative care, in which existential loneliness mainly related to the forthcoming death. The older person's home, as the place where home care or palliative care was received, helped preserve the older person's identity. In hospital and palliative care, as in institutional care, the place offered security, while in residential care, the place could make older people feel like strangers. Creating relationships was considered an important part of the professionals' role in all four care contexts, although this had different meanings, purposes and conditions.

CONCLUSIONS

The context of care matters and influences how professionals view existential loneliness among older people and the opportunities they have to address existential loneliness.

IMPLICATIONS FOR PRACTICE

Support for professionals must be tailored to their needs, their education levels and the context of care. Professionals need training and appropriate qualifications to address existential loneliness related to existential aspects of ageing and care.

Job strain in nursing homes-Exploring the impact of leadership

AIMS AND OBJECTIVES

To explore the association between nursing home managers' leadership, job strain and social support as perceived by direct care staff in nursing homes.

BACKGROUND

It is well known that aged care staff experience high levels of job strain, and that aged care staff experiencing job strain are exposed to increased risk for adverse health effects. Leadership styles have been associated with job strain in the literature; however, the impact of perceived leadership on staff job strain and social support has not been clarified within nursing home contexts.

DESIGN

This study had a cross-sectional design.

METHODS

Participating staff (n = 3,605) completed surveys which included questions about staff characteristics, valid and reliable measures of nursing home managers' leadership, perceived job strain and social support. Statistical analyses of correlations and multiple regression analysis with interaction terms were conducted.

RESULTS

Nursing home managers' leadership were significantly associated with lower level of job strain and higher level of social support among direct care staff. A multiple regression analysis including an interaction term indicated individual and joint effects of nursing home managers' leadership and social support on job strain.

CONCLUSIONS

Nursing home managers' leadership and social support were both individually and in combination associated with staff perception of lesser job strain. Thus, nursing home managers' leadership are beneficial for the working situation and strain of staff.

RELEVANCE TO CLINICAL PRACTICE

Promoting a supporting work environment through leadership is an important implication for nursing home managers as it can influence staff perception of job strain and social support within the unit. By providing leadership, offering support and strategies towards a healthy work environment, nursing home managers can buffer adverse health effects among staff.