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

First-line managers´ perceptions of missed nursing care in community health care for older people-A phenomenographic study

INTRODUCTION

First-line managers in Swedish communities have responsibility for that care to older people is provided, staffing is sufficient and the budget is balanced in their unit. It is a struggle with limited resources due to a growing population in need of care. This can lead to missed nursing care. The aim was to describe first-line managers´ perceptions of missed nursing care in community health care for older people.

METHODS

A qualitative design with a phenomenographic approach, interviewing 24 first-line managers. Ethics approval for the study was received from the Research Ethics Committee at Karlstad University (Dnr HNT 2020/566).

RESULTS

The results are shown in six descriptive categories containing 15 perceptions. The descriptive categories are 'occurrence of missed nursing care', 'becoming aware of missed nursing care', 'reasons for missed nursing care', 'missed nursing care has consequences for the older persons', 'missed nursing care has consequences for the staff' and 'taking action to decrease missed nursing care'.

CONCLUSIONS

It is important for first-line managers to become aware of the existence and reasons for missed nursing, as it has consequences for older people and staff. Managers need to take missed nursing care seriously in order to work with improvements for maintaining good quality of care and patient safety.

Dietetics student contribution to addressing malnutrition in residential aged care facilities

AIMS

To test a model of malnutrition screening and assessment conducted by dietetics students on placement in residential aged care facilities. The secondary aim was to identify possible facilitators and barriers to the implementation of the model.

METHOD

The type 1 hybrid effectiveness-implementation trial study design and reporting outcomes were developed using the Consolidated Framework for Implementation Research. An innovative placement model was developed, where students on voluntary placement visited three residential aged care facilities to identify residents at risk of malnutrition using currently available screening tools for older people. Students completed malnutrition assessments for all residents using the subjective global assessment tool.

RESULTS

Thirty-two students participated; 31 completed all three sessions, with malnutrition screening completed for 207 residents and malnutrition assessment for 187 residents (July and September 2022). Based on the subjective global assessment, 31% (n = 57) of residents were mildly/moderately malnourished, and 3% (n = 5) were severely malnourished. The Innovation Domain of the Framework was the most important consideration before implementation.

CONCLUSION

Whilst previous research documented student learning opportunities in residential aged care facilities, this study provides the first available evidence of the direct contribution students can make to the health of aged care residents through malnutrition screening and assessment. The model enables students to conduct malnutrition screening and assessment feasibly and efficiently in facilities that do not routinely collate and act on these data. With a limited nursing aged care workforce to undertake this vital task, the potential role of student dietitians to fulfil this role must be considered.

Burnout in residential aged care managers: a scoping review

Residential aged care managers play an important role which can influence outcomes for their staff, their residents, and the organisations they work for. Burnout in residential aged care employees has been researched however burnout in residential aged care managers has received little attention. This scoping review sought to identify literature examining burnout in residential aged care managers.

To investigate the literature currently available on what stressors were experienced by residential aged care managers that led to burnout.

This scoping review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist.

Five databases were searched, including CINAHL, MEDLINE, EMCARE, SCOPUS, and INFORMIT using primo search. The first review of title and abstracts was conducted by three authors to determine eligibility, using the program JBI SUMARI. Two authors were involved in the final screening of each full-text article. Where disagreement occurred, a collaborative discussion took place until consensus was reached. The review included peer-reviewed journal articles focusing on burnout, stress, fatigue, moral distress, exhaustion, or resilience in residential aged care managers or leaders published after 2012 in English.

An initial search of the databases found 275 articles, of which 5 articles met the inclusion criteria for final review. Articles were categorised into the following groups Responsibilities, Reaction, and Regulation. These groups encapsulated risk factors for burnout in residential aged care managers.

As a result of the scoping review, it is suggested that burnout in residential aged care managers can be attributed to environmental stressors, those being situational and organisational (Maslach, 2003), which are outside the control of the individual. Strategies that support residential aged care managers to manage and lessen the phenomenon of burnout require further exploration.

Health-care leaders' and professionals' experiences and perceptions of compassionate leadership: A mixed-methods systematic review

PURPOSE

The purpose of this study is to identify and synthesise the best evidence on health-care leaders' and professionals' experiences and perceptions of compassionate leadership.

DESIGN/METHODOLOGY/APPROACH

A mixed-methods systematic review was conducted in accordance with the Joanna Briggs Institute methodology for mixed-methods systematic reviews using a convergent integrated approach. A systematic search was done in January 2023 in PubMed, CINAHL, Scopus, Medic and MedNar databases. The results were reported based on Preferred Reporting Items for Systematic Reviews and Meta-analyses. The data was analysed using thematic analysis.

FINDINGS

Ten studies were included in the review (five qualitative and five quantitative). The thematic analysis identified seven analytical themes as follows: treating professionals as individuals with an empathetic and understanding approach; building a culture for open and safe communication; being there for professionals; giving all-encompassing support; showing the way as a leader and as a strong professional; building circumstances for efficient work and better well-being; and growing into a compassionate leader.

PRACTICAL IMPLICATIONS

Compassionate leadership can possibly address human resource-related challenges, such as health-care professionals' burnout, turnover and the lack of patient safety. It should be taken into consideration by health-care leaders, their education and health-care organisations when developing their effectiveness.

ORIGINALITY/VALUE

This review synthesised the knowledge of compassionate leadership in health care and its benefits by providing seven core elements of health-care leaders' and professionals' experiences and perceptions of compassionate leadership.

The Influence of Care Home Managers' Leadership on the Delivery of Person-Centred Care for People Living with Dementia: A Systematic Review

Background

Care home managers' leadership is recognised as directly influencing the care received by people living with dementia. What enables care home managers to promote and sustain person-centred care for residents is less well understood.

Method

A mixed-methods systematic review synthesised evidence on care home managers' leadership on the delivery of person-centred care for people living with dementia. Electronic databases (PubMed, Scopus, Cochrane Library, CINAHL, and Google Scholar) were searched between 2009-2021. Thematic synthesis identified commonalities, facilitators, and barriers to managers enabling person-centred care.

Results

Twenty-one studies met the inclusion criteria. Approaches demonstrated by care home managers that enabled person-centred care for people living with dementia included valuing and recognising staffs' work; involving residents and relatives in decision making; providing feedback to staff; promoting a positive work environment and care culture; and involving staff in organisational changes. Barriers to person-centred care were a lack of organisational support for care home managers; staff shortages; managers not having time to work with staff; manager-staff turnover; limited access to dementia training; and a lack of leadership education and training for care home managers.

Conclusion

Care home managers are central to the delivery of person-centred care for people living with dementia. The review identified key resources and activities that support this work. The wide variation in leadership approach and a persistent lack of detail about the frequency of educational and organisational support demonstrate a need to explore what enables care home managers to support their staff to deliver person-centred care.

Leading with a cool head and a warm heart: trait-based leadership resources linked to task performance, perceived stress, and work engagement

Leaders of today need to achieve well in terms of task performance, perceiving low stress, and having high levels of work engagement. One may ask whether trait-based leadership resource factors can be identified and how such resource factors might relate to task performance, perceived stress, and work engagement. Our aim was to test the hypothesis, derived from Hobfoll's motivational Conservation of Resources (COR) theory, that there are trait-based leadership resource factors, which are differentially correlated to the leaders' task performance, perceived stress, and work engagement. Leaders (N = 344) aged from 23 to 65 years (M = 49, SD = 8.6; 58% women) completed an online questionnaire including measures of task performance, perceived stress, work engagement, personality traits, trait emotional intelligence, empathy, performance-related self-esteem, compassionate and rational leadership competence, and coping resources for stress. Using exploratory factor analysis, we identified four trait-based leadership resource factors. With Bonferroni adjustment, and controlling for sex, age, number of years in the current managerial position, self-deceptive enhancement, and impression management, only Rational Mastery was significantly positively correlated with task performance. Rational Mastery, Efficient Coping, and Modesty were negatively correlated with perceived stress, and all factors except Modesty, but including the fourth (Good-Heartedness) were positively correlated with work engagement. Organizations striving for sustainable work conditions should support trait-based leadership, which depends not only on a task-oriented resource such as rational mastery, but also on human-oriented resources such as efficient coping, modesty, and good-heartedness, all of them being differentially related to task performance, perceived stress, and work engagement.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03767-8.

NURSES' RATINGS OF COMPASSIONATE NURSING LEADERSHIP DURING THE COVID -19 PANDEMIC - A DESCRIPTIVE CROSS-SECTIONAL STUDY

Aim

The aim of this study is to investigate how intensive and emergency nurses rated the adequacy of compassionate leadership during the early stages of the Covid‐19 pandemic.

Background

The pandemic has resulted in nurses' increased stress and need for compassion from leaders. Compassionate leadership is here defined as a number of leadership practices based on altruistic values and emotional intelligence.

Method

This is a quantitative descriptive cross‐sectional study based on a questionnaire for 50 intensive and emergency care nurses in a central hospital in Finland.

Results

The pandemic had increased nurses' need for compassion, but their needs for support had not been met and their strengths and competence appreciated sufficiently. They agreed that compassionate leadership could be developed through experience and personal development rather than through education.

Conclusion

Compassionate leadership is a process that involves a number of leadership practices based on altruistic values and emotional intelligence and benefits from recognition and use of employee strengths. Leaders and employees could benefit from simulation‐based learning, work supervision and discussion led by external facilitators.

Implications for Nursing Management

Compassionate leadership involves approachability, genuine presence and listening, which could be developed through work‐based learning combined with reflection.

Senior manager leadership competencies for quality residential aged care: an Australian industry perspective

Background

Documented poor quality and standards of care in Australia’s residential aged care (RAC) sector have highlighted a need to better understand the role of and skills required by, RAC senior management personnel to address these concerns. This study examined which senior management leadership skills and personal qualities are necessary to deliver and strengthen the quality of RAC, with the aim of improving understanding of the professional development needs of leaders in the sector.

Methods

We conducted 12 in-depth interviews with Australian aged care industry experts, including academics, and representatives from the primary health network, consumer, and provider advocate groups. Abductive, thematic analysis incorporated coding derived from existing leadership skills frameworks as well as inductively identified themes.

Results

Identified leadership skills were grouped into five domains including i) workforce development and retention, ii) governance and business acumen; iii) health systems knowledge; iv) stewardship and v) responding to regulatory and political contexts. Skills particularly emphasised by participants were those required to recruit and retain a skilled workforce, manage relationships, and promote a positive organisational culture and employee wellbeing.

Conclusions

RAC senior managers require a complex mix of business, human resource management, and clinical skills to deliver quality care in Australia’s complex RAC setting. The lack of any professional development framework to guide the acquisition or updating of those skills is a concern.

Managing maternal and child health nurses undertaking family violence work in Australia: A qualitative study

AIM

To explore the experience of nurse managers managing maternal and child health nurses undertaking family violence work in Victoria, Australia.

BACKGROUND

Health care practitioners' ability to address violence against women is strengthened by health service systems that include effective staff management and leadership. Maternal and child health nurses work with women experiencing abuse; however, their support by the health system and their managers has not been examined.

METHOD

Semi-structured interviews with 12 nurse managers in 2019-2020 explored how they supervised and managed nurses. The data were analysed using reflexive thematic analysis.

RESULTS

We identified three themes-(a) managing the service: being resourceful; (b) supporting nurses' emotional safety; and (c) hitting the ground running: the demands on the manager.

CONCLUSION

Inadequate support for nurse managers undermines workplace well-being and role satisfaction, impacting the safety and supervision of nurses doing family violence work.

IMPLICATIONS FOR NURSING MANAGEMENT

An integrated family violence systems approach must include improved training and support for nurse managers to enable reflective practice and ensure effective support for nurses working with women experiencing abuse.