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

Conceptualizing the learning organization in nursing homes: a scoping review

BACKGROUND

Maintaining high-quality care in nursing homes is challenging. An ageing population and labour market shortages have created an imbalance in the supply and demand of care, and the focus of care has transitioned from quality of care to quality of life. This study explores how the 'learning organization' (LO) concept could contribute to a new quality paradigm in nursing homes, by 1) examining its efficacy and operationalization for and 2) identifying the elements most relevant to the nursing home setting.

METHODS

We use Arksey and O'Malley's scoping framework to answer the research questions and address gaps in the literature, guided by theories on the learning organization from Senge (The fifth discipline: The art and practice of the learning organization, 1990) and Watkins and Marsick (Sculpting the learning organization: Lessons in the art and science of systemic change, 1993). Literature searches (in Scopus, Medline, Web of Science, Business Source Elite, and ERIC) were performed from inception through 19 August 2024, in collaboration with a medical information specialist. Eligibility was limited to studies on learning organizations or organizational learning (OL) in nursing homes. Study aims, definitions, descriptions, key terms, theories, and operationalizations were mapped descriptively.

RESULTS

From 2,292 abstracts, 14 articles were included. Ten studies reference Senge (The fifth discipline: The art and practice of the learning organization, 1990) and/or Watkins and Marsick (Sculpting the learning organization: Lessons in the art and science of systemic change, 1993) in defining and describing a learning organization and organizational learning. Together, the studies reveal six elements of learning organizations in nursing homes: individual and collective learning, individual and interpersonal abilities, an adaptive and responsive culture, transformational leadership, organizational knowledge development, and systems thinking. All studies highlight organizational performance improvement as the primary aim of a learning organization, with only a few operationalizations (n = 3) examining the concept's full scope; most examine only single aspects.

CONCLUSIONS

To help nursing homes effectively adapt, the learning organization could offer a promising concept. However, current research is limited. The included studies provide insight into key elements of learning organizations and their benefits for organizational performance and job satisfaction. Future research should develop a consistent method of operationalization based on the six key elements most relevant for nursing homes transitioning to learning organizations. This approach should consider the interconnected nature of these elements, with systems thinking as the foundation.

Psychosocial work characteristic profiles and health outcomes in registered nurses at different stages of their careers: a cross-sectional study

BACKGROUND

Individual psychosocial work characteristics have been associated with the health and well-being of registered nurses. However, it remains to be determined whether different types of psychosocial work characteristics form patterned profiles and whether the profiles are associated with registered nurses' health and welfare at different stages of their careers. The purpose of this study was to identify latent psychosocial work characteristic profiles and examine whether the profiles are associated with a certain career stage and health outcomes.

METHODS

This cross-sectional study was conducted with 624 early-career registered nurses and 1,016 later-career registered nurses. Data were collected using an electronic survey with internationally validated measures including the Organizational Justice Scale, the Nurse Stress Index Scale, the Job Content Questionnaire, the Team Climate Inventory, the Psychological Distress Questionnaire, the Sleep Problems Questionnaire, and the Self-Rated Health Questionnaire. Latent profile analysis was conducted to identify subgroups with similar psychosocial work characteristic profiles. Multinomial and linear regression analyses were used to examine the association between latent work characteristics profiles, stage of career, and health outcomes.

RESULTS

We identified five profiles. The profiles were named based on class descriptions. The low strain/high support profile group and the moderate strain/high support profile group had statistically better self-rated health (p = < 0.001), less psychological distress (p = < 0.001) and less sleep problems (p = < 0.001) compared to the high strain/low support profile group.

CONCLUSIONS

Low to moderate strain, high interactional and procedural justice, and participative safety in teams form patterned profiles associated with better health in registered nurses. High strain, a lack of justice and a lack of participation safety form a risk combination pattern profile that may lead to health problems in registered nurses. Promoting procedural and interactional justice, and participation safety in teams seems efficient in enhancing the health and well-being of registered nurses. The findings indicate no significant correlation between career stages and work characteristic profiles. It is crucial to identify stressors specific for career stages and develop tailored interventions.

Individual and organizational interventions to promote staff health and well-being in residential long-term care: a systematic review of randomized controlled trials over the past 20 years

BACKGROUND

Staff in residential long-term care (RLTC) experience significant physical and mental work demands. However, research on specific interventions to promote staff health and well-being in RLTC facilities is limited. This systematic review aimed to synthesize the current evidence on health promotion interventions among RLTC staff.

METHODS

A comprehensive systematic literature review was conducted on studies published between January 2000 and April 2023. Four electronic databases were searched, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PsychArticles via EBSCO. The review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The methodological quality of the included studies was assessed using the Risk of Bias Assessment tool (RoB 2).

RESULTS

A total of 26 publications, referring to 23 different interventions with a randomized controlled design were included. Among these interventions, ten used training/educational approaches, six used behavioral approaches, and seven employed a multimodal approach. Significant improvements in health and well-being outcomes were found in four interventions using a training/educational approach, three interventions using a behavioral approach, and four interventions using a multimodal approach. Within the interventions studied, twelve specifically targeted the reduction of job demands, while only one intervention exclusively addressed job resources among RLTC staff. Furthermore, ten interventions addressed primary outcomes that encompassed both job demands and job resources.

CONCLUSION

Current evidence for health promotion interventions among RLTC staff is still limited, but research suggests that there is potential to improve certain outcomes related to RLTC staff health and well-being. Future research is recommended to contemplate a tailored intervention design that encompasses both individual-level and organizational-level approaches, and gender-specific physiological and sociological characteristics of RLTC staff. Moreover, detailed reporting of the development process, and research on the interaction between job demands and resources of RLTC staff are also recommended.