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Job strain in nursing homes: exploring the impact of leadership
Umeå University, Faculty of Medicine, Department of Nursing. (U-age SWENIS)ORCID iD: annica.backman@umu.se
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 7-8, p. 1552-1560Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To explore the association between nursing home managers' leadership, job strain and social support as perceived by direct care staff in nursing homes.

Background: It is well known that aged care staff experience high levels of job strain, and that aged care staff experiencing job strain are exposed to increased risk for adverse health effects. Leadership styles have been associated with job strain in the literature; however, the impact of perceived leadership on staff job strain and social support has not been clarified within nursing home contexts.

Design: This study had a cross‐sectional design.

Methods: Participating staff (n = 3,605) completed surveys which included questions about staff characteristics, valid and reliable measures of nursing home managers' leadership, perceived job strain and social support. Statistical analyses of correlations and multiple regression analysis with interaction terms were conducted.

Results: Nursing home managers' leadership were significantly associated with lower level of job strain and higher level of social support among direct care staff. A multiple regression analysis including an interaction term indicated individual and joint effects of nursing home managers' leadership and social support on job strain.

Conclusions: Nursing home managers' leadership and social support were both individually and in combination associated with staff perception of lesser job strain. Thus, nursing home managers' leadership are beneficial for the working situation and strain of staff.

Relevance to clinical practice: Promoting a supporting work environment through leadership is an important implication for nursing home managers as it can influence staff perception of job strain and social support within the unit. By providing leadership, offering support and strategies towards a healthy work environment, nursing home managers can buffer adverse health effects among staff.

Place, publisher, year, edition, pages
2018. Vol. 27, no 7-8, p. 1552-1560
Keywords [en]
aged care, leadership, long-term care, management, nursing home care, stress, support
National Category
Nursing
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
URN: urn:nbn:se:umu:diva-146494DOI: 10.1111/jocn.14180ISI: 000430825100062PubMedID: 29148598Scopus ID: 2-s2.0-85040863850OAI: oai:DiVA.org:umu-146494DiVA, id: diva2:1196751
Funder
Vårdal FoundationForte, Swedish Research Council for Health, Working Life and WelfareSwedish Research CouncilAvailable from: 2018-04-11 Created: 2018-04-11 Last updated: 2018-09-25Bibliographically approved
In thesis
1. Leadership: person-centred care and the work situation of staff in Swedish nursing homes
Open this publication in new window or tab >>Leadership: person-centred care and the work situation of staff in Swedish nursing homes
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2018. p. 71
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1957
Keywords
Leadership, organisation, person-centred care, psychosocial climate, work environment, nursing homes, nursing
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-146499 (URN)9789176018675 (ISBN)
Public defence
2018-05-04, Vårdvetarhusets, aula, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research CouncilVårdal Foundation
Available from: 2018-04-13 Created: 2018-04-11 Last updated: 2018-06-09Bibliographically approved

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Backman, AnnicaSjögren, KarinLövheim, HugoEdvardsson, David

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