Moral distress among nurses is well researched and well documented, but there is limited research on the moral distress experienced by care leaders, who serve as intermediaries between patient care nurses and higher levels of administration. Healthcare professionals experience moral distress daily in the context of older adult care. The aim of this scoping review was to evaluate recent literature on moral distress in older adult care with the goal of revealing how care leaders’ experiences of moral distress in older adult care have been conceptualized in earlier studies. The research questions were: How is the concept of moral distress as experienced by care leaders in older adult care defined in the existing literature? How is the concept of moral distress conceptualized in the literature? The research has been conducted in accordance with the guidelines set forth by the Finnish National Advisory Board on Research Ethics TENK. We saw that consensus on how moral distress is defined is lacking. Care leaders in older adult care experience substantial moral distress, which could be linked to the duality of their leadership role. Moral distress can be caused by a complex interplay of individual and structural factors and the challenging complex moral issues inherent to older adult care. Moral distress could impact care leaders’ emotional health, job performance, overall job satisfaction and result in higher turnover rates, absenteeism, decreased quality of patient care, and increased organizational costs. Addressing moral distress on the individual, team, and organizational levels is crucial for enhancing care leaders’ well-being and improving the overall quality of care for older adults. A focus on the identification of strategies whereby care leaders can be supported, exploration of the long-term effects of moral distress on healthcare professionals in general, and the organizational outcomes associated with moral distress should be included in future research.

Purpose

The purpose of this paper is to describe first-line managers’ (FLMs’) experiences and reflections on structural conditions for management practice within hospital settings using Kanter’s theory of structural empowerment.

Design/methodology/approach

A qualitative deductive approach with a descriptive design was used. Interviews were conducted with 11 FLMs in charge of medical or surgical hospital units spread across Sweden. Data were analyzed using a directed content analysis, based on Kanter’s theory of structural empowerment, encompassing such as access to necessary and sufficient resources, information, support and opportunities to learn and develop.

Findings

Findings of this study from the FLMs’ descriptions and reflections shed light on the impact of power dynamics on the structural conditions for management practice. The availability of nursing staff was a fundamental resource in the FLMs’ work performance, ensuring delivery of care to patients and a sound work environment for staff. Additionally, the other structural elements outlined in Kanter’s theory were evident in the findings, as the FLMs wished for structured information flow, identified potential and challenged opportunities for development and emphasized the importance of receiving support from people with a genuine understanding of their work situation.

Originality/valueThe results of this study contribute to the understanding of FLMs’ structural conditions for management practice in hospital settings. The paper’s originality stems from the use of a deductive approach, providing a structured lens with the potential to inform future research and practice in the field of health-care management.

Background

Nurses work in a knowledge-intensive sector with high demands for lifelong learning. Thriving is a positive psychological state, including a sense of mutual learning and vitality at work. Research on thriving, its antecedents and outcomes is called for. The study aim was to examine thriving as a mediator in the relationships between telephone nurses’ structural empowerment and the outcomes work-personal life benefits, job performance, work-related stress symptoms and turnover intentions, as well as to psychometrically test the Thriving Scale (Swedish version).

Methods

Questionnaire data, a national sample of 409 Swedish telephone nurses, were collected, and relationships were examined using multiple regression analyses with PROCESS macro. Factorial validity of the Thriving Scale was tested using confirmative factor analyses.

Results

There were statistically significant relationships between structural empowerment and the outcomes (work-personal life benefits, job performance, stress symptoms, turnover intentions), and these relationships were mediated by thriving. The Thriving Scale showed good internal consistency, and an acceptable to borderline mediocre fit for factorial validity. Thirty-two percent reported turnover intentions.

Conclusions

Good access to structural empowerment increases nurses’ thriving, which in turn improves work-personal life benefits, job performance, and decreases stress symptoms and turnover intentions. Managers should strive to improve nurses’ thriving at work, emphasizing good access to empowering structures.

Background

Span of control (SOC) has been used as a description of the number of individual employees that a manager is responsible for and is often used for assessing first-line managers' (FLMs') scope of responsibilities. However, there are arguments that SOC should include more factors than number of direct reports to illustrate the diversity and complexity of FLMs' responsibilities in hospital settings. Mentions of being an objective instrument including such factors have been made of 'The Ottawa Hospital Clinical Managers Decision-Making Tool' (TOH-SOC) which includes three decision-making categories: unit-, staff- and program-focused. The unit-focused category includes two indicators: unit complexity and material management. The staff-focused category includes four indicators: volumes of staff directly reporting to the FLM, autonomy of the team, staffing stability, and diversity of staff. The program-focused category includes two indicators: diversity and budgetary responsibilities. The TOH-SOC tool is referred to in both international reviews and Swedish reports as an instrument for assessing FLMs' scope of responsibilities, but published results from using it are limited. Hence, there is a need to further test the instrument's validity, reliability, and generalizability in different settings and countries. 

Aim

The aim of this study is to investigate how the TOH-SOC describes the span of control of hospital first-line managers at medical and surgical units in Sweden and what descriptions and reflections first-line managers have regarding the instument's content validity and clinical usefulness.

Methods

A mixed method design with an explanatory sequential approach is used and includes three stages; the first is quantitative data collection and analysis, the second is asking how the results from stage one can be used in stage three, which, last and ongoing, includes a quantitative and qualitative data collection and analysis. The participants in stage one was driven from a randomized sample of Swedish hospital FLMs at medical and surgical units, and in stage three, the participants consisted of a subsample of FLMs included in stage one. Descriptive statistics are used to describe respondents' demographics and their span of control. From the interviews, quantitative and qualitative viewpoints on the TOH-SOC is analyzed with the standard method for computing an item-level content validity index (I-CVI) .78 or higher and qualitative content analysis.

Results

Results from the first stage showed how the majority out of the total 33 FLMs scored as having an appropriate span of control, according to the scoring guidelines described in the TOH-SOC tool. Although the results from the first stage are in line with earlier research, questions for clarification regarding the instrument have been identified. These questions, along with initial results from the second and last stage, identifying how norms differ between the origin of the instrument and the Swedish context, imply a need to further test and develop the instrument to be relevant in hospital context and, in particular, Swedish hospital medical and surgical units. More detailed results will be presented later this year.

Background: Leadership and access to structural empowerment are known to influence the work life experiences of staff and quality of care. Knowledge about relationships between specific factors of structural empowerment, leadership and management, staff well-being and quality of care at both an individual and unit level is scarce.

Aim: To study the relationship between staff-rated access to empowering structures, leadership and management performance, well-being, and quality of care in hospital settings measured at the individual level and aggregated at the unit level.

Methods: A cross-sectional correlative design was applied. Questionnaire data from 331 randomized hospital nursing staff working at 38 units in 25 hospitals in Sweden were analyzed using bivariate correlations and general estimation equation (GEE) models.

Results: Results from the bivariate analysis of relationships confirmed earlier research. In the GEE models, some unexpected results were found and differences between the individual and unit levels. Adding management and leadership as independent factors in the second model showed few relationships of significance to the outcome variables.

Conclusion: Results confirm the importance of staff access to empowering structures in relation to well-being and quality of care. Differences and similarities were shown when studying these relationships at both the individual and unit level. The findings feature implications for hospital management to promote staff access to empowering structures. The findings provide information on how these structures relate to the individual and the unit; information that could be useful when planning or implementing strategies with the aim to promote staff well-being and care quality. The non-significant results for leadership and management in relation to staff outcomes in the GEE-models, raise questions for further research where a shift from individual to organizational focused performances within the field of leadership is implied.

Objective: Because antiemetics have become more effective and integrative therapies such as acupuncture are used in combination with antiemetics, people receiving chemotherapy for cancer today might expect less emesis than in the past. It is not previously described if and how people receiving modern antiemetics during chemotherapy experience emesis. The objective of this study was to describe experiences regarding emesis among persons undergoing emetogenic chemotherapy, and how it affects their quality of life, daily life and work. A further aim was to describe views on the significance of treatment expectations and communication with healthcare personnel while undergoing chemotherapy for cancer.

Method: Fifteen participants (median age 62 years, n = 1 man and n = 14 women, with breast (n = 13) or colorectal (n = 2) cancer) undergoing adjuvant or neo-adjuvant highly or moderately emetogenic chemotherapy were interviewed individually. The data were then analyzed using inductive thematic analysis.

Results: Three themes described the participants’ experiences: “Your whole life is affected, or continues as usual,” covering descriptions of emesis limiting some participants’ everyday lives, while others experienced no emesis at all or had found ways to manage it. Overall, participants described satisfaction with their antiemetic treatment. “Experiences and expectations more important than information”, that is, the participants reported wanting all the information they could get about possible adverse effects of treatment, although they believed previous experiences were more important than information in creating expectations about treatment outcomes. The participants reported that being seen as a unique person was of utmost importance: “Meet me as I am.” This creates trust in healthcare personnel and a feeling of safety and security in the situation.

Conclusions: These findings underline the importance of person-centered care and support in creating positive treatment expectations. Future research is called for regarding the potential antiemetic effects of positive communication regarding strengthening positive treatment expectations during emetogenic chemotherapy.

Introduction

Since antiemetics have become more effective, it seems plausible that patients nowadays expect less emesis than in the past. To gain a deeper understanding of the patients’ caring needs during emetogenic chemotherapy used today, the aim was to describe patients’ experiences of chemotherapy-induced emesis and how it afects quality of life, daily life, and work. Further, to describe views of the signifcance of their treatment expectations and the communication with the health care personnel when undergoing chemotherapy for cancer.

Methods

Fifteen patients (median age 62 years, n=1 man and n=14 women, with breast (n=13) or colorectal (n=2) cancer), undergoing adjuvantor neo-adjuvant highly or moderately emetogenic chemotherapy were interviewed individually. The data were then analyzed using inductive thematic analysis.

Results

Three themes described the patients’ experiences: ”The whole life gets affected, or goes on as usual”, covering descriptions of how some patients experienced the emesis to limit their everyday lives, while others experienced no emesis at all or had found ways to manage it; ”Information is important for creating expectations, but experiences even more”, i.e., the patients expressed that they wanted all the information they could get about possible adverse efects from the treatment, even though they believed previous experiences to be more important than information for creating expectations about treatment outcomes. Overall, the participants described satisfaction with their antiemetic treatment; and ”Meet me as I am”, including the participants expressed being seen as a unique person to be the of utterly importance. It creates trust in the health care personnel and a feeling of safety and security in the situation.

Conclusions

These findings underline the importance of person-centered care ands upport in creating positive treatment expectations. Future research is welcomed regarding potential antiemetic efects of positive communication, strengthening positive treatment expectations during emetogenic chemotherapy

AIM: The aim was to study how first-line managers act to make structural empowerment accessible for nursing staff. Furthermore, to relate these observations to the manager's and their nursing staff's descriptions regarding the staff's access to empowering structures.

BACKGROUND: Staff access to empowering structures has been linked to positive workplace outcomes. Managers play an important role in providing the conditions for structural empowerment.

METHOD: Five first-line managers were observed for two workdays. Managers and staff (n=13) were thereafter interviewed. Field notes and interviews were analyzed using directed content analysis.

RESULTS: The managers displayed intentional actions that could enable their staff access to empowering structures. Managers and staff described the importance of staff's access to empowering structures.

CONCLUSION: Staff who perceive to have access to structural empowerment have managers who are present and available. Unanimity among managers and staff existed in regard to the importance of staff having access to structural empowerment. The managers work continually and intentionally, doing many things at the same time, to provide the staff access to empowering structures.

IMPLICATIONS FOR NURSING MANAGEMENT: The study shows the importance of promoting managers' awareness of staff's access to structural empowerment and maximizing managers' presence and availability to their staff.

Background

In times where hospitals are struggling with recruitment as well as keeping their current workers healthy and willing to stay on, it is important to identify factors that can help work organizations in their work of providing conditions for a good work environment and for a leadership that promotes health and development.

Objective

The aim was to study how first-line managers act at units where the staff has rated their access to empowering structures as high and to describe this together with the first-line managers' and their staff's descriptions regarding the staff's access to empowering structures by using Kanter's theory of structural empowerment as a framework. 

Method

A descriptive design with a qualitative approach collecting data using both observations and interviews. The study sample consisted of five first-line managers (FLM) and 13 staff members, at hospital units in different parts of Sweden, where the staff had rated their access to empowering structures as high using the Conditions of Work Effectiveness Questionnaire – II (CWEQ II) in a previous data collection.

Both the first and last author conducted 80 hours of observations, following each FLM during two workdays, and 15 hours of interviewing both the FLMs and staff members. Fieldnotes of what the FLMs were doing were taken during the observations. On the third day at the unit, interviews were conducted with the FLM and two or three out of their staff. The interviews were semi-structured with questions related to the observations and questions inspired by Kanter’s theory. Data from both MP3 files and notebooks were transferred into a Word document and directed content analysis informed by Kanter’s theory was performed on the material as a whole.

Results

Preliminary results from the ongoing analysis indicate that findings in both the observations and interviews often confirm and support each other.