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Characteristics of highly rated leadership in nursing homes using item response theory
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
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2017 (Engelska)Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, nr 12, s. 2903-2913Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aim: To identify characteristics of highly rated leadership in nursing homes. Background: An ageing population entails fundamental social, economic and organizational challenges for future aged care. Knowledge is limited of both specific leadership behaviours and organizational and managerial characteristics which have an impact on the leadership of contemporary nursing home care. Design: Cross-sectional. Method: From 290 municipalities, 60 were randomly selected and 35 agreed to participate, providing a sample of 3605 direct-care staff employed in 169 Swedish nursing homes. The staff assessed their managers' (n = 191) leadership behaviours using the Leadership Behaviour Questionnaire. Data were collected from November 2013 - September 2014, and the study was completed in November 2016. A two-parameter item response theory approach and regression analyses were used to identify specific characteristics of highly rated leadership. Results: Five specific behaviours of highly rated nursing home leadership were identified; that the manager: experiments with new ideas; controls work closely; relies on subordinates; coaches and gives direct feedback; and handles conflicts constructively. The regression analyses revealed that managers with social work backgrounds and privately run homes were significantly associated with higher leadership ratings. Conclusion: This study highlights the five most important leadership behaviours that characterize those nursing home managers rated highest in terms of leadership. Managers in privately run nursing homes and managers with social work backgrounds were associated with higher leadership ratings. Further work is needed to explore these behaviours and factors predictive of higher leadership ratings.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2017. Vol. 73, nr 12, s. 2903-2913
Nyckelord [en]
item response theory, leadership, long-term care, management, nursing home care
Nationell ämneskategori
Omvårdnad
Identifikatorer
URN: urn:nbn:se:umu:diva-143945DOI: 10.1111/jan.13353ISI: 000418365200012PubMedID: 28556986OAI: oai:DiVA.org:umu-143945DiVA, id: diva2:1174260
Tillgänglig från: 2018-01-15 Skapad: 2018-01-15 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Ingår i avhandling
1. Leadership: person-centred care and the work situation of staff in Swedish nursing homes
Öppna denna publikation i ny flik eller fönster >>Leadership: person-centred care and the work situation of staff in Swedish nursing homes
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Swedish nursing home managers, who constitute the empirical focus of this thesis, hold overall operational responsibility for the nursing homes, which includes the care of residents, direct care staff and work environment. Aged care organisations are also expected to provide person-centred care. Working towards a person-centred approach poses new demands and leads to challenges for leaders, and there is currently limited knowledge of what characterises leadership that promotes a person-centred approach. In addition, an ongoing demographic shift in the aged care workforce entails further challenges, as the proportion of professional workers is decreasing. Leading a healthy work environment is therefore important for ensuring and protecting staff health. Based on this, it is important to explore nursing home managers’ leadership in relation to person-centred care and the work situation of staff.

Aim: The overall aim was to explore leadership in relation to person-centred care and the work situation of staff in Swedish nursing homes.

Methods: This thesis is based on data from two data collections. First, it includes cross-sectional baseline data from a national inventory of health and care in Swedish nursing homes (SWENIS) collected in 2013-2014. The SWENIS dataset consists of a sample of staff n=3605 from 169 nursing homes in 35 municipalities, and nursing home managers n=191. The second data collection consists of 11 semi-structured interviews with 12 nursing home managers in highly person-centred nursing homes that already participated in SWENIS. Data were explored via descriptive statistics, simple and multiple regression analyses, and qualitative content analysis.

Results: Leadership was positively associated with person-centred care and psychosocial climate. Highly rated leadership behaviors’ among nursing homes managers was characterized by experimenting with new ideas, controlling work closely, relying on his/her subordinates, coaching and giving direct feedback, and handling conflicts constructively. Leading person-centred care can be outlined by four leadership processes: embodying person-centred being and doing; promoting a person-centred atmosphere; maximizing person-centred team potential and optimising person-centred support structures. Leadership was also positively associated with social support and negatively associated with job strain. Further, the variation in leadership was to a very small extent explained by the nursing home managers’ educational qualification, operational form of the nursing home and the number of employees in a unit.

Conclusions: All findings point in the same direction: that leadership, as it is characterized and measured in this thesis, is significantly associated with person-centred care provision as well as with the work situation of staff. This suggests that nursing managers have a central leadership role in developing and supporting person-centred care practices, and also in creating a healthy work environment. The results also highlight five specific leadership behaviours that are most characteristic of highly rated leadership, thereby adding concrete descriptions of behaviours to the literature on existing leadership theories. The findings also include four central processes for leading towards person-centred care in nursing homes. Taken together, it seems important for managers to translate the person-centred philosophy into actions and to promote an atmosphere pervaded by innovation and trust, in which cultural change is enhanced by positive cultural bearers. Utilizing the overall knowledge and competencies among staff and potentiating care teams was also considered important for leading person-centred care, along with optimising supportive structures for supporting and maintaining person-centred care. If aged care organisations are to be committed to person-centred care, an important implication seems to be to organise nursing homes in a way that allows nursing home managers to be close and present in clinical practice and actively lead towards person-centred care. The findings of this thesis contribute to our understanding of leadership in relation to person-centre care and the work situation of staff. These findings can be used in leadership educations and nursing curriculum. Longitudinal studies would be valuable for following leadership, person-centred care and the work situation of staff over time.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2018. s. 71
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1957
Nyckelord
Leadership, organisation, person-centred care, psychosocial climate, work environment, nursing homes, nursing
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:umu:diva-146499 (URN)9789176018675 (ISBN)
Disputation
2018-05-04, Vårdvetarhusets, aula, Umeå, 09:00 (Svenska)
Opponent
Handledare
Forskningsfinansiär
Forte, Forskningsrådet för hälsa, arbetsliv och välfärdVetenskapsrådetVårdalstiftelsen
Tillgänglig från: 2018-04-13 Skapad: 2018-04-11 Senast uppdaterad: 2018-06-09Bibliografiskt granskad

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