Aim To study the leadership and management skills of first-line managers (FLMs) of elderly care and their work environment in Egypt and Sweden. Background FLMs in Egypt and Sweden are directly responsible for staff and quality of care. However, FLMs in Sweden, in elderly care, have smaller units/organizations to manage than do their colleagues in Egypt. Furthermore, family care of the elderly has been the norm in Egypt, but in recent years institutional care has increased, whereas in Sweden, residential living homes have existed for a longer period. Methods A convenience sample of FLMs, 49 from Egypt and 49 from Sweden, answered a questionnaire measuring leadership and management skills, structural and psychological empowerment, job satisfaction and psychosomatic health. Results In both countries, FLMs' perceptions of their leadership and management skills and psychological empowerment were quite high, whereas scores for job satisfaction and psychosomatic health were lower. FLMs had higher values in several factors/study variables in Egypt compared with in Sweden. Conclusion and implications The work environment, both in Egypt and Sweden, needs to be improved to increase FLMs' job satisfaction and decrease stress. The cultural differences and levels of management have an effect on the differences between the two countries.

AIMS AND OBJECTIVES: To investigate healthcare personnel's working conditions in relation to risk behaviours for organism transmission.

BACKGROUND: Healthcare personnel's behaviour is often influenced by working conditions that in turn can impact the development of healthcare-associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients.

DESIGN: A mixed-methods convergent design.

METHODS: Data were collected during 104 h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first-line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed-methods research.

RESULTS: Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient-level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high-need patients.

CONCLUSIONS: These mixed-methods findings illustrate that healthcare personnel's perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety.

RELEVANCE FOR CLINICAL PRACTICE: The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work.

BACKGROUND: Nurses’ working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees’ behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions.

OBJECTIVE: To investigate the relationship between nurses assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress.

METHODS: A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed.

RESULTS: The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254–0.268. Significant differences in self-efficacy were found in the grouped working conditions.

CONCLUSIONS: This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.

BACKGROUND: The importance of staff working life for staff well-being has been demonstrated in several studies; less research has focused on staff working life and older persons' satisfaction with care.

PURPOSE: The study aim was to study relationships between 1) staff assessments of their structural conditions/empowerment in elderly care, psychological empowerment, and job satisfaction and (2) older persons' satisfaction with care.

METHODS: A multilevel, cross-sectional, and correlational design was applied using questionnaire data on working life (1021 staff members) and unit-level data (40 elderly care units) on older persons' satisfaction with care.

RESULTS: Statistically significant relationships were found between all 3 working life variables and older persons' satisfaction with care. Furthermore, the results revealed an indirect/mediating effect of job satisfaction between structural empowerment and satisfaction with care, but not for psychological empowerment.

CONCLUSIONS: Staff structural empowerment, psychological empowerment, and job satisfaction are linked to older persons' satisfaction with care.

AIM:

To describe district nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management; and to examine associations between the variables.

BACKGROUND:

Obesity is increasing worldwide and primary care could play a central role in the management.

METHODS:

Questionnaire data were collected from 247 nurses in 33 centres.

RESULTS:

The most common activities performed weekly were; advice about physical activity (40.1%) and general lifestyle advice (34.8%). However, nearly one third seldom/never performed these activities. Approximately half seldom/never performed BMI assessment and even fewer waist circumference (78.1%). Values for the factors Importance of obesity and Personal effectiveness were skewed towards a positive view and Negative view close to neutral. Multivariate analysis revealed that nurses with specialized tasks, longer working experience and higher perceived personal effectiveness performed more clinical activities.

CONCLUSION:

Managers need to make efforts to engage all personnel in obesity management; and strategies to increase self-efficacy are called for.

Working life and stress symptoms among caregivers in elderly care with formal and no formal competence Aim  The aim of the present study was to describe and compare caregivers with formal and no formal competence on job satisfaction, psychosomatic health, structural and psychological empowerment and perceptions of care quality. A further aim was to study relationships among study variables. Methods  A convenience sample of 572 caregivers in elderly care participated. Results  Caregivers with no formal competence perceived higher workload, more communication obstacles, less competence, poorer sleep and more stress symptoms than did their colleagues. Linear regression analyses revealed that the factor self-determination was an explanatory variable of stress levels among caregivers with no formal competence, and self-determination and impact among caregivers with formal competence. Linear regression analysis revealed that different dimensions in structural and psychological empowerment explained the variance in staff job satisfaction, perceived stress symptoms and quality of care. Conclusions  No formal competence seems to be a risk factor for psychosomatic health problems. Implications for nursing management  Managers need to have a strategic plan for how to create a working environment for caregivers with no formal competence. Caregivers' self-determination seems to be important for stress symptoms. Meaning, self-determination, impact and opportunities appear to be important for job satisfaction and competence, opportunities, resources and formal power for quality of care.

Aim

To describe male first-line managers' experiences of their work situation in elderly care.

Background

First-line managers' work is challenging. However, less attention has been paid to male managers' work situation in health care. Knowledge is needed to empower male managers.

Method

Fourteen male first-line managers were interviewed. The interview text was subjected to qualitative content analysis.

Result

Work situations were described as complex and challenging; challenges were the driving force. They talked about ‘Being on one's own but not feeling left alone’, ‘Having freedom within set boundaries’, ‘Feeling a sense of satisfaction and stimulation’, ‘Feeling a sense of frustration’ and ‘Having a feeling of dejection and resignation’.

Conclusion

Although the male managers report deficiencies in the support structure, they largely experience their work as a positive challenge.

Implications for nursing management

To meet increasing challenges, male first-line managers need better access to supportive structural conditions. Better access to resources is needed in particular, allowing managers to be more visible for staff and to work with development and quality issues instead of administrative tasks. Regarding organisational changes and the scrutiny of management and the media, they lack and thus need support and information from superiors.

BACKGROUND:

The work situation for first-line managers in elderly care is complex and challenging. Little is known about these managers' work situation from a structural and psychological empowerment perspective.

AIM:

To describe first-line managers' experiences of their work situation in elderly care from a structural and psychological empowerment perspective.

METHOD:

Interviews from 14 female first-line managers were analysed using qualitative content analysis.

RESULTS:

The theme described the managers' work situation as "It's not easy, but it's worth it." In the four subthemes, the managers described their work in terms of "Enjoying a meaningful job," "A complex and demanding responsibility that allows great authority within set boundaries," "Supported by other persons, organisational preconditions and confidence in their own abilities" and "Lacking organisational preconditions, but developing strategies for dealing with the situations."

CONCLUSION:

The managers described having various amounts of access to structural empowerment and experienced a feeling of meaning, competence, self-determination and impact, that is, psychological empowerment in their work.

IMPLICATIONS FOR NURSING MANAGEMENT:

It is vital that first-line managers have access to organisational support. Therefore, upper management and first-line managers need to engage in continuous dialogue to customize the support given to each first-line manager.

AIM: To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance.

BACKGROUND: Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers.

METHOD: In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services.

RESULTS: First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates.

CONCLUSIONS: Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance.

IMPLICATIONS FOR NURSING MANAGEMENT: Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

Aim

To study whether the number of subordinates plays a role in first-line managers’ and subordinates’ ratings of empowerment, stress symptoms, and leadership–management performance. The aim was also to study relationships between managers’ empowerment and stress symptoms and leadership–management performance.

Methods

A longitudinal and correlational design was used. All first-line managers (n = 98) and their subordinates (n = 2085) working in the care of older adults in five municipalities were approached.

Results

With fewer (≤ 30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with ≥ 31 subordinates. Furthermore, structural empowerment was related to the managers’ stress symptoms and leadership–management performance, mediated through psychological empowerment. Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms.

Conclusion

The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership–management performance they rated over time.

District nurses are preceptors of district nurse students at the postgraduate level. These district nurse students are already registered nurses who have graduated and are now studying to become district nurses; this training is at the postgraduate level. As preceptors at the postgraduate level, district nurses play an important role in helping these students to achieve the learning outcomes of the clinical practice part of their education. However, there is a lack of studies on precepting at this level. Thus, the aim was to describe district nurses' experiences of precepting district nurse students at the postgraduate level. The study was descriptive in design and used a qualitative approach. Purposive sampling was used and nine district nurses from seven primary health care units in Sweden were interviewed. Data were analysed using qualitative content analysis. An overall theme ”Fluctuating between transferring knowledge and striving for reflective learning” and two subthemes emerged. The preceptors’ views on precepting and performance varied depending on the situation. The conclusions is that given the current learning outcomes for clinical practice education at the postgraduate level, district nurses need to bemore influenced by preception focused on reflective learning.

The aim of the study was to describe nursing students' reflections on caring for end-of-life patients in a youth volunteer service. A purposive sample of 11 nursing students in one province in China were interviewed and diaries were collected. The data were analysed using qualitative content analysis. The students described the service as “an empowering care that makes a difference – but not without challenges on different levels”. The service was said to provide devoted caring adjusted to the person's need, condition and wishes. According to the students, the service had an impact on them; the internal and/or external support was stimulating and rewarding, whereas deficient support was frustrating and made them feel helpless. They emphasized the need for improvements at different levels. In conclusions, the youth volunteer service empowers both patients and students and can be seen as person-centred care. The students' professional knowledge, skills and ability improved, while these aspects were still perceived as deficient. Appropriate curriculum and training for nursing students are necessary and should be tailored to improving students' caring ability and confidence. Expanding the service was emphasized and suggestions for improvements were identified.

BACKGROUND: To understand healthcare personnel's infection prevention behaviour has long been viewed as a key factor in preventing healthcare-associated infections. Suboptimal hand hygiene compliance and handling of materials, equipment and surfaces present the main risks for potential organism transmission. Further exploration is needed regarding the role of context-specific conditions and the infection prevention behaviours of healthcare personnel. Such knowledge could enable the development of new intervention strategies for modifying behaviour.

AIM: To describe risk behaviours for organism transmission in daily care activities over time.

METHODS: Unstructured observations of healthcare personnel carrying out patient related activities were performed on 12 occasions over a period of 18 months.

FINDINGS: Risk behaviours for organism transmission occur frequently in daily care activities and the results shows that the occurrence is somewhat stable over time. Interruptions in care activities contribute to an increased risk for organism transmission that could lead to subsequent healthcare-associated infection.

CONCLUSION: Interventions aimed at reducing the risks of healthcare-associated infections need to focus on strategies that address: hand hygiene compliance; the handling of materials, equipment, work clothes and surfaces; as well as the effects of interruptions in care activities if they are to alter healthcare personnel's infection prevention behaviour sufficiently.

Background

The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored.

Objective

To describe students' motives to become registered nurses and their expectations regarding their future profession.

Design

A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.

Participants and setting

A purposive sampling of a group with initially 75 students starting a three-year nursing program at a university in Sweden.

Methods

A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students' education. At data collection two and three, a copy of the earlier answers was attached. Data were analysed using manifest and latent content analysis.

Results

An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education.

Conclusion

The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.

The objective was to explore individuals' experiences and understandings of meticillin-resistant Staphylococcus aureus (MRSA) colonisation. Thirteen interviews were performed and processed using content analysis, resulting in the theme ‘Invaded, insecure and alone’. The participants experienced fears and limitations in everyday life and expressed a need to protect others from contagion. Moreover, they experienced encounters with, and information from, healthcare workers differently: some were content, whereas others were discontent. The described fears, limitations and inadequate professional–patient relationship generated unacceptable distress for MRSA-colonised persons. Thus, the healthcare sector should assume responsibility for managing MRSA, and healthcare workers must improve their professionalism and information skills, so as to better meet MRSA-colonised persons' needs

Background: Patient-professional interactions and adherence to infection control measures are central to the quality of care and patient safety in healthcare. Persons colonized with methicillin-resistant Staphylococcus aureus (MRSA) describe insufficient support and unprofessional behavior among healthcare personnel. Methods: A descriptive qualitative study was conducted to investigate managers', physicians', registered nurses' and MRSA-colonized persons' experiences of patient-professional interactions in relation to and responsibilities for infection prevention in the care of colonized patients. Five persons with MRSA colonization and 20 healthcare personnel employed within infection, hematology, nephrology or primary healthcare settings participated. The data were collected using open-ended semi-structured individual interviews with the MRSA-colonized persons and semi-structured focus group interviews with the healthcare personnel. Results: The participants perceived MRSA as an indefinable threat and described that the responsibility for infection prevention is important, but such adherence was a neglected and negotiable issue. The described actions that were acknowledged as unprofessional and inappropriate adherence to infection prevention resulted in stigmatized patients. Conclusion: Colonized persons' and healthcare personnel's understanding of MRSA determines whether the personnel's behavior is perceived as proper or improper. Individual responsibility for patient-professional interactions in relation to MRSA colonization and adherence to infection control measures should be more stringent.

BACKGROUND: Errors in infection control practices risk patient safety. The probability for errors can increase when care practices become more multifaceted. It is therefore fundamental to track risk behaviours and potential errors in various care situations.

OBJECTIVE: The aim of this study was to describe care situations involving risk behaviours for organism transmission that could lead to subsequent healthcare-associated infections.

DESIGN & SETTING: Unstructured nonparticipant observations were performed at three medical wards.

PARTICIPANTS & METHODS: Healthcare personnel (n=27) were shadowed, in total 39h, on randomly selected weekdays between 7:30 am and 12 noon. Content analysis was used to inductively categorize activities into tasks and based on the character into groups. Risk behaviours for organism transmission were deductively classified into types of errors. Multiple response crosstabs procedure was used to visualize the number and proportion of errors in tasks. One-Way ANOVA with Bonferroni post Hoc test was used to determine differences among the three groups of activities.

RESULTS: The qualitative findings gives an understanding of that risk behaviours for organism transmission goes beyond the five moments of hand hygiene and also includes the handling and placement of materials and equipment. The tasks with the highest percentage of errors were; 'personal hygiene', 'elimination' and 'dressing/wound care'. The most common types of errors in all identified tasks were; 'hand disinfection', 'glove usage', and 'placement of materials'. Significantly more errors (p<0.0001) were observed the more multifaceted (single, combined or interrupted) the activity was.

CONCLUSION: The numbers and types of errors as well as the character of activities performed in care situations described in this study confirm the need to improve current infection control practices. It is fundamental that healthcare personnel practice good hand hygiene however effective preventive hygiene is complex in healthcare activities due to the multifaceted care situations, especially when activities are interrupted. A deeper understanding of infection control practices that goes beyond the sense of security by means of hand disinfection and use of gloves is needed as materials and surfaces in the care environment might be contaminated and thus pose a risk for organism transmission.

There is a need for validated assessment tools for measuring attitudes towards patients with multidrug- resistant bacteria. Such an assessment tool was developed and psychometrically evaluated in the present study. A literature review and discussions with experts and key informants were used to develop the questionnaire. To ensure item adequacy and interpretability, face validity and pre-tests were performed. Item validity, content validity and internal consistency reliability were evaluated in a non-random sample of 329 hemodialysis nurses. The psychometric properties were satisfactory, indicating good item validity. The content validity revealed three appropriate factors with good internal consistency reliability. The haemodialysis nurses’ knowledge about multidrug-resistant bacteria was not suf. cient, and their intentional behaviour was unsatisfactory with respect to infection control precautions. The multidrug-resistant bacteria Attitude Questionnaire would be a valuable tool, in nursing practice and nursing education, in promoting quality improvements in patient safety with regard to healthcare associated infections.

Aim. To assess the discriminative and construct validity of the Multidrug-Resistant Bacteria Attitude Questionnaire and to study registered nurses knowledge of, behaviour toward and emotional responses to patients with multidrug-resistant bacteria in relation to how they understand their own, managers and politicians responsibility for adherence to preventive measures for infection control. Background. Multidrug-resistant organisms are a global problem and an essential topic in healthcare regarding patient safety improvement. Design. Descriptive and correlational cross-sectional survey. Method. Data were collected in a non-random sample consisting of 397 registered nurses; district, haematology or infection registered nurses. One-way analysis of variance and independent t-tests were used for comparisons and a principal component analysis was performed. Results. Discriminative and construct validity were supported, as the infection registered nurses generally had higher scores on knowledge, behaviour and emotional response, compared with district registered nurses and haematology registered nurses and the three-factor solution was confirmed. Registered nurses with higher scores on knowledge and emotional response attributed greater responsibility to themselves and to politicians. The Multidrug-Resistant Bacteria Attitude Questionnaire was translated using a forward-back translation process. Conclusion. The questionnaire has adequate psychometric properties. Insufficient knowledge of, behaviour toward and emotional response to patients with multidrug-resistant bacteria were described, but the registered nurses did estimate their own responsibility for adherence to preventive measures for infection control as being great or very great. Relevance to clinical practice. There is a considerable need to improve knowledge, behaviour and emotional response regarding infection prevention measures among healthcare workers. The hospital management are responsible for such improvements and the Multidrug-Resistant Bacteria Attitude Questionnaire is useful in identifying such needs, as it has adequate psychometric properties and is able to discriminate between groups. Evaluation among healthcare workers may indicate where to situate additional training, as this is of clinical significance for safe care.

Background

The wearing of gloves is included in the standard principles for preventing healthcare associated infections. A continued wearing of gloves may, however, result in the transmission of organisms instead of preventing infections. Few studies have explored how common it is for surfaces to be touched by potentially contaminated gloves.

Methods

Secondary analysis of field notes from 48 hours of unstructured observations of healthcare personnel's actions during patient care. The new focus was on to what extent healthcare personnel wore gloves that should have been removed or changed, what surfaces were touched by contaminated gloves and what patient-related activities were involved.

Results

A continued wearing of gloves occurred in about half of the observed episodes of patient care. On average, 3.3 surfaces were touched by contaminated gloves. The surfaces most frequently touched were ‘unused single-use items’, ‘equipment controls/switches/regulators/flush buttons’ and ‘bed linen’. This occurred mostly while helping patients with ‘personal hygiene’, when performing ‘test taking’ or during procedures involving the operation of medical or other ‘equipment’.

Conclusion

The continued wearing of gloves during patient-related activities carries the risk of organism transmission, as the gloves touch many surfaces. The most critical moments seem to be when the use of gloves is considered essential. A better understanding of the motivators of improper glove-use behaviour is needed to develop interventions that rectify the improper use of gloves.

Aim: To explore the perceptions of infection control practices among healthcare personnel and evaluate the use of authentic vignettes as a means to alter infection control behavior.

Method: Four authentic vignettes were used as a part of reflective dialogues with healthcare personnel. An evaluation of the dialogues was performed with six healthcare personnel using the focus group technique. Qualitative content analysis was used to analyze the data.

Results: The mind-set to help one another and do one’s best in every situation was described as a core aspect in preventing the transmission of microorganisms. Having support, taking personal responsibility, being knowledgeable about infection control practices, and having a reasonable workload were seen to play decisive roles in controlling the spread of infection. Discussing authentic comprehensible vignettes with colleagues during the allotted time was considered a valuable method for improving infection control practices.

Conclusion: Meaningful insights on how best to use vignettes as a means to improve infection control practice were gained. These findings should be considered when designing theory-driven interventions in different contexts, which are aimed at improving infection control practices in health care.

Purpose

Management and leadership in health care are described as complex and challenging, and the span of control is known to be a key component in the manager’s job demands. The implementation of change can be a challenge in health care, and managers often have roles as implementation leaders. Little attention has been given to how managers perceive the process of implementation. Thus, this study aims to explore second-line managers’ perceptions of, prerequisites for and experiences from the implementation of changes in their manager’s work conditions.

Design/methodology/approach

A grounded theory–based qualitative design was used. Data were collected from a purposive sample of nine second-line managers by individual semi-structured interviews. The three stages of initial coding, focus codes and axial coding were used in data analysis.

Findings

Three thematic areas were identified: engagement, facilitation and achievement. The second-line managers’ descriptions suggest that the change work entails a complex challenge with an unclear result. Involvement, consideration for the context and facilitation are needed to be able to conduct a cohesive implementation process.

Originality/value

This study findings outline that to succeed when implementing change in complex organizations, it is crucial that managers at different levels are involved in the entire process, and that there are prerequisites established for the facilitation and achievement of goals during the planning, implementation and follow-up.

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.

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.

During clinical practice, preceptors play an important educational role in helping nursing students become secure and effective practitioners. For this educational role they need adequate preparation. The aim of the present prospective study was to describe preceptors' experiences of their educational role before and after attending a university preceptor preparation course. This 7.5-credit, Master's level course is offered on a part-time basis and covers one semester. The theoretical approach was self-directed and reflective learning. Twentyseven preceptors participated in group interviews before and after the course, and data were analyzed using qualitative content analysis. The findings revealed a shift in preceptors' perceptions. Their view of the educational role changed from being characterized by individual experiences and notions to being guided by personal and formal demands. Before the course, the lack of sufficient preconditions for preceptorship predominated, whereas after the course participants described ways of creating such preconditions. Before the course, the supervisory process was described as teaching, whereas after the course it was described as a learning process for students. Using reflective learning in a preceptor preparation course can develop and strengthen preceptors' view of their educational role and help them manage and create the preconditions for preceptorship.

BACKGROUND: In Sweden the national fundamental values for care of older people state that care should ensure that they can live in dignity and with a sense of well-being. Our hypothesis was that a caregiver intervention targeting the national fundamental values would improve perceived empowerment, person-centered climate and life satisfaction among older people living in residential facilities.

METHODS: The study was a cluster-randomized controlled trial with a pre- and one post-test design, conducted in 27 units (17 study units) at 12 residential facilities for older people in five municipalities in central Sweden. The units in each municipality were randomly assigned to intervention or control group. The caregiver intervention was carried out using an interpretative approach with eight guided face-to-face seminars, where self-reflection and dialogue were used. Data were collected using questionnaires. The number of residents was 43 (78 %) in the intervention group and 37 (71 %) in the control group. The Chi-square test and Mann-Whitney U-tests were performed to detect differences between groups and Wilcoxon signed rank tests to explore differences in change over time within groups. Furthermore, generalized estimating equation (GEE) models were used to study effects of the intervention controlling for clustering effects.

RESULTS: Primary outcome measures were empowerment, person-centered climate and life satisfaction. In the intervention group, improvements at follow-up were found in residents' self-reported empowerment (n = 42; p = 0.001, Median difference 4.0, 95 % CI 1.5;6.0), person-centered climate (n = 42; p ≤0.001, Median difference 8.0, 95 % CI 4.5;11.4) and life satisfaction regarding the factor quality of everyday activities (n = 40; p = 0.033, Median difference 9.7, 95 % CI 1.0;21.9) while disempowerment decreased (n = 43; p = 0.018, Median difference -1.3, 95 % CI -2.0;0.0). In the control group person-centered climate decreased (n = 37; p = 0.002, Median difference -8.5, 95 % CI -13.6;-3.0) and quality of everyday activities (n = 36; p = 0.012, Median difference -11.6, 95 % CI-21.7;-3.4). Change over time between groups was significant for empowerment (p = 0.001, Median difference 6.0, 95 % CI 3.0;9.0), disempowerment (p = 0.006, Median difference -2.0, 95 % CI -4.0;-1.0) and person-centered climate (p ≤ 0.001, Median difference 16.0, 95 % CI 9.7;23.0) and for life satisfaction regarding the factor quality of everyday activities (p = 0.002, Median difference 22.1, 95 % CI 8.2;37.4). Results of GEE confirmed earlier results; revealed interaction effects for empowerment (parameter estimate -5.0, 95 % CI -8.3;-1.8), person-centered climate (parameter estimate -16.7, 95 % CI -22.4;-10.9) and life satisfaction regarding the factor quality of everyday activities (parameter estimate -25.9, 95 % CI -40.3;-11.5).

CONCLUSION: When the Swedish national fundamental values were put into practice increases in empowerment, person-centered climate and quality of everyday activities were found among older people with intact cognitive ability living in residential facilities. Limitations to consider are the differences between the two groups at baseline, drop-outs and that neither the data collector nor the outcome assessors were blinded to group assignment of participants.

TRIAL REGISTRATION: The study was registered in ISRCTN92658034 in January 2013.

Purpose: Dignity and well-being are key aspects of the legislation and policies that regulate care of older persons worldwide. In addition, care of older persons should be person-centred. Dignity and well-being are described as results of person-centred care (PCC). The purpose of this study was to gain an understanding of important aspects for older persons to experience dignity and well-being in residential care facilities (RCFs).

Design/methodology/approach: This study had a qualitative approach, and individual semi-structured interviews were conducted with 20 older persons living in RCFs. Data were analysed using inductive content analysis.

Findings: To experience dignity and well-being older persons emphasized the importance of preserving their identity. To do this, it was important to be able to manage daily life, to gain support and influence and to belong to a social context. However, the findings indicate a need for improvements. Practical implications: Insights into older persons’ experiences of important aspects for experiencing dignity and well-being in RCFs can be used by first-line managers and registered nurses when designing improvement strategies to promote PCC.

Originality/value: Dignity and well-being are described as results of PCC. The findings provide an understanding of what older persons perceive as important for experiencing dignity and well-being in RCFs. The findings are useful when designing improvement strategies to promote PCC.

Person-centred care has been shown to have positive outcomes for patients and for staff. However, the complexity of the link between structural conditions, work in a person-centred manner and outcomes for staff is insufficiently described. We tested the relationship between structural empowerment and psychological empowerment, as mediated by nursing home staff members’ self-ratings of working in a person-centred manner, the person-centred climate and thriving. Questionnaires were distributed to staff working in 12 nursing homes in Sweden. A serial mediation model was tested. The results showed that higher access to structural empowerment was related to higher psychological empowerment mediated by staff working in a more person-centred manner, improved person-centred climate, and improved staff ratings of thriving. These results point to the importance of strengthening the preconditions for staff to work in a person-centred manner and nursing home managers play an important role in this.

Aim: To estimate the validity and reliability of the Leadership and Management Inventory, a tool to measure the skills and abilities of first-line nurse managers. Background: The decision to develop an inventory reflects the need for an instrument that can measure the various skills and abilities first-line nurse managers should possess. Method: Factor analysis was conducted and internal consistency initially estimated on data from 149 registered nurses; a second sample of 197 health care personnel was used to test these results. Results: Principal component analysis of the first sample resulted in a preferred three-factor solution that explained 65.8% of the variance; Cronbach's alpha coefficient varied between 0.90 and 0.95. Analysis of the second sample also resulted in a three-factor solution that explained 64.2% of the variance; Cronbach's alpha coefficient varied from 0.88 to 0.96. For both samples, the factors were labelled 'interpersonal skills and group management', 'achievement orientation' and 'overall organizational view and political savvy'. Conclusion: Results indicate that estimates of validity and reliability for the Leadership and Management Inventory can be considered acceptable. Implications for nursing management: The Leadership and Management Inventory can be used when first-line nurse managers' leadership and management skills and abilities are to be measured.

Aims and objectives

In this study, the aim was to understand health care personnel's expectations and experiences of participating in an intervention aimed at the implementation of three assessment scales for fall injuries, malnutrition and pressure ulcers, and the performance of preventive measures in these areas over the period of 18 months.

Background

Fall injuries, malnutrition and pressure ulcers among older people are challenging issues for caregivers at different levels in the health care system.

Design

A descriptive design with a qualitative approach was used to follow health care personnel before, during and after implementation of a care prevention intervention.

Methods

Twelve health care personnel with different professions at the hospital, primary care and municipal care levels participated in a preventive care introduction. Seminars were held at four occasions, with assignments to be completed between seminars. Lectures and group discussions were performed, and three risk assessment scales were introduced. The participants were interviewed before, during and after the introduction. Manifest and latent content analysis were used.

Results

The main results are presented in the theme ‘Patient needs are visualised through a gradually developed shared understanding’ and in five categories. The work approach of performing three risk assessments simultaneously was perceived as positive and central to ensuring quality of care; it was not, however, perceived as unproblematic.

Conclusion

The participants as well as health care team members showed a positive attitude towards and described the advantages of being given opportunities for shared understanding to improve patient safety and to provide structure for the provision of good care.

Relevance to clinical practice

The managerial approach of listening to and acting on issues stressed by health care personnel is important to ensure ongoing and future improvement initiatives.

Aim: To elucidate first-line managers' descriptions and reflections regarding their staff's access to empowering structures using Kanter's theory of structural empowerment. Background: Good structural conditions within workplaces are essential to employees' wellbeing, and their ability to access empowerment structures is largely dependent on the management. Method: Twenty-eight first-line managers in elderly care were interviewed. Deductive qualitative content analysis was used to analyse data. Results: Managers perceived that staff had varying degrees of access to the empowering structures described in Kanter's theory - and that they possessed formal power in their roles as contact persons and representatives. The descriptions mostly started from the managers' own actions, although some started from the needs of staff members. Conclusion: All managers described their staff's access to the empowering structures in Kanter's theory as important, yet it seemed as though this was not always reflected on and discussed as a strategic issue. Implications for nursing management: Managers could make use of performance and appraisal dialogues to keep up to date on staff's access to empowering structures. Recurrent discussions in the management group based on such current information could promote staff's access to power through empowering structures and make job definitions a strategic issue in the organisation.

Purpose

The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden.

Design/methodology/approach

Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061).

Findings

The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results.

Originality/value

The instrument measures both leadership and management performance and can be used to continually measure managers’ performances as perceived by staff to identify areas for development.

Objective: To study the reasons for first-line nurse managers to resign, their perceptions of difficult situations, experience of support and satisfaction with work. Background The intentions of first-line nurse managers' to stay at their posts varied between 45% and 75% in different studies. Methods: Data were collected by questionnaire and letters from 32 first-line nurse managers who had left their posts. Qualitative content analysis was used to analyse the letters. Results: Eleven first-line nurse managers resigned due to reorganization or other changes and 19 due to their own accord. Reasons to leave were personal, organizational, as well as lack of support from and relations to the head of department. Difficult situations were unclear conditions, lack of support from supervisors and, implementation of changes, staff matters and economy. Important support was personal, organizational, practical and to have opportunities for development and education. The perception of work satisfaction was higher after resignation. Conclusions: The dominant reason to leave was reorganization and other changes. The relation to the head of department influenced the first-line nurse managers' overall work situation.

Aim To study the perception of the first-line nurse managers (FLNMs), registered nurses (RNs), assistant nurses (ANs) and head of departments (HDs) on the FLNM's current and desired roles. Background In the process of decentralization, the role of FLNM has changed from having overall responsibility for patients to having responsibility for the management of the ward. Method Interviews with five FLNMs, five RNs, five ANs, and one HD were used. Qualitative content analysis was used to analyse the transcribed text. Results When describing the current roles, the FLNMs, RNs and ANs focused on the coordination of activities that contributed to a well-functioning service and care of patients as well as on the recruitment of, support to and development of the personnel. The HD focused on the FLNM's responsibilities towards the personnel, especially regarding empowerment and staff well-being. When describing desired roles, the FLNMs, RNs and ANs emphasized service on the ward while the HD underlined the development of services and co-operation with other nurse managers. Conclusion The perception of the current and desired roles of the FLNM varied among the groups. The FLNMs, RNs and ANs reported a similar understanding which in turn differed from that of the HD who described fewer roles and focused on other areas.

Purpose – The purpose of this paper is to contribute new knowledge about how first line managers (FLMs) in elderly care perceive their situation, with a focus on differences in management approaches at the intersection of the central and local parts of the organization.

Design/methodology/approach – The present study has a qualitative approach and is part of a larger project on FLMs in elderly care. The results presented here are based on a secondary analysis of 15 of the totalof 28 interviews carried out in the project.

Findings – Themain results are twofold: the majority of FLMs perceived differences in management approaches between local and central management; the differences caused some struggle because FLMs perceived that the management system did not support the differences. The two main aspects that caused the FLMs to struggle were differences in the foci of the management levels and difficulties in influencing the conditions ofmanagement.

Originality/value – The results contribute to the debate on what aspects are important to sustainable management of elderly care. It is common knowledge that FLMs have a complex position, intermediate to the central, upper level management and their subordinates at the local level – levels with different foci and interests. The study contributes new knowledge about what these differences consist of and the dilemmas they cause and offers suggestions as to what can be done to reduce both energy waste and the risk of low job satisfaction.

BACKGROUND:

Patients' participation is essential to their well-being and sense of coherence, as well as to their understanding of and adherence to prescribed treatments. Ward rounds serve as a forum for sharing information between patient and caregiver. The purpose of the ward round is to obtain information and plan medical and nursing care through staff-patient communication.

AIM AND OBJECTIVE:

The aim and objective of this study was to investigate patients' experiences during the ward round and their ability to participate in their care.

METHODOLOGICAL DESIGN AND JUSTIFICATION:

The study was qualitative and descriptive in design. Fourteen inpatients at a cardiovascular ward were interviewed. Qualitative content analysis was used for the analysis.

ETHICAL ISSUES AND APPROVAL:

The ethics of scientific work were adhered to. Each study participant gave his/her informed consent based on verbal and written information. The study was approved by the Research Ethics Committee at Uppsala University.

RESULTS:

The analysis revealed one theme and three subthemes related to patients' experiences of ward rounds. The main theme was handling of information from the daily ward round while waiting for private consultation. The subthemes were making the best of the short time spent on ward rounds; encountering traditional roles and taking comfort in staff competency; and being able to choose the degree to which one participates in the decision-making process.

CONCLUSIONS:

Several aspects of traditional ward round routines could be improved in regard to the two-way information exchange process between caregivers and patient. Patients' and caregivers' ability to communicate their goals and the environment in which the communication occurs are of great importance. The information provided by nurses is easier to understand than that provided by physicians. The atmosphere must be open; the patient should be treated with empathy by staff; and patients' right to participate must be acknowledged by all healthcare professionals involved.

Few studies have focussed on patients’ experiences of and suffering due to mediastinitis following Coronary Artery by-passGraft (CABG). Mediastinitis creates a complex and invasive experience for the patient with prolonged hospitalisation, and would be expected to be a significant stressor. The aim of the present study was to capture patients’ experiences of themedical and nursing care they received for mediastinitis following CABG. Content analysis revealed three themes withregard to how the patients coped with the stress and threats of mediastinitis and its treatment and how they thought it wouldinfluence their future life. A first theme centred on physical and psychological discomfort and impact on autonomy. Thestaff ’s medical knowledge and the quality of nursing care as well as the patients’ understanding of the situation influencedtheir experience. A second theme was how patients dealt with perceived danger and stress. Coping strategies such asproblem solving, information seeking, dissociation, distraction, minimisation and expression of emotion were used to handlethe situations. The third theme comprised the patients’ belief that the mediastinitis would not affect the outcome of theCABG procedure, even though their confidence in this was influenced by uncertainty about the rehabilitation process.

Den psykiatriska vården har genomgått genomgripande förändringar på senare år. I Gästrikland genomfördes omorganisationen huvdsakligen under andra hälften av 1980-talet. Då minskades den slutna vården till förmån för en utbyggd och decentraliserad öppen vård. Under 1990-talet förändrades förutsättningarna genom att nya regler får vårdköp mellan sjukvårdsdistrikten infördes. Samtidigt minskade de ekonomiska ramarna. Detta kan ha bidragit till att slutenvården fortsatt att minska. Genom patientinventeringar 1985, innan förändingsarbetet tog fart, 1991, efter sektoriseringens genomförande och 1993, i skedet efter sektoriseringen, kunde förändringar i patientsammansättning och vårdtider avläsas. Drivkraften bakom förändringarna diskuteras.

Psychiatric inpatient care and the availability of hospital beds: A comparison of three catchment areas. The psychiatric care in Gävleborg county was formerly centralized to a mental hospital and a small psychiatric department at a general hospital. It was then decided that the care system should be reorganized. The county was divided into three catchment areas. Each of these will have a comprehensive psychiatric care with both in- and out-patient facilities, but the intramural care will be reduced considerably. During the reorganization phase an almost experimental situation existed, as accessibility and availability of hospital beds differed among the three sectors. The inpatients for each sector were counted, and some patient characteristics were compared. Except for a considerable difference in the use of hospital beds small differences were otherwise noted. The sector with the smallest number of inpatients had relatively more schizophrenic patients. The accessibility and availability of hospital beds seemed to decide the number of inpatients even when deinstitutionalization was an accepted common goal. Local habits and traditions may also be important.

The so-called sectorization of the psychiatric care system has been connected with deinstitutionalization and possibly also a forced discharge from hospital for some long-term inpatients. In Gävleborg County 96 patients who had been hospitalized for at least 1 year were discharged in the years 1984-88, when the reduction of hospital beds was at its peak. Their situation was investigated in the autumn of 1989, when members of the psychiatric staff evaluated their living conditions and asked the patients to complete a questionnaire. At that time 19 patients had been readmitted to hospital, 4 had moved to other parts of the country, and 3 were dead. Thus at least 70 were still living outside institutions, but 2 of these could not be reached. The material consists of the other 68 patients. Forty of them were diagnosed as being schizophrenic. Twenty-two patients had spent some time in hospital after the index discharge. Forty-three lived in their own lodgings, 14 in group homes, and 11 in homes for the elderly. Forty-one lived alone, and this was more often the case for male patients. Only one had a job and earned his living, but 41 took part in some organized activity like work therapy or study groups. About 50% of the patients had regular contact (at least once a month) with the local psychiatric department, and the same frequency was noted for regular contact with the district nurses. Only seven patients had no such contacts. According to the staffs judgement, about two of three patients had enough psychosocial support and a satisfactory quality of life. Resources for rehabilitation, activation, and social contacts were reported to be inadequate. The patients had a more positive view and were largely satisfied with their living conditions. Only four wanted to return to the hospital. The schizophrenic patients tended to have a more satisfactory life situation according to the staff, and they were also rehospitalized less frequently than other patient categories. There is a notable group of chronically ill patients with other psychiatric diagnoses, which need as much support as the schizophrenic group. When resources are lacking, the need for cooperation with social authorities, primary care, and clients' organizations is apparent.