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Leadership: person-centred care and the work situation of staff in Swedish nursing homes
Umeå University, Faculty of Medicine, Department of Nursing. (U-age SWENIS)
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 [en]
Leadership, organisation, person-centred care, psychosocial climate, work environment, nursing homes, nursing
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-146499ISBN: 9789176018675 (print)OAI: oai:DiVA.org:umu-146499DiVA, id: diva2:1196831
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 FoundationAvailable from: 2018-04-13 Created: 2018-04-11 Last updated: 2018-06-09Bibliographically approved
List of papers
1. Towards person-centredness in aged-care: exploring the impact of leadership
Open this publication in new window or tab >>Towards person-centredness in aged-care: exploring the impact of leadership
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2016 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 6, p. 766-774Article in journal (Refereed) Published
Abstract [en]

Aim: To explore the association between leadership behaviours among managers in aged care, and person‐centredness of care and the psychosocial climate.

Background: Theory suggests that leadership is important for improving person‐centredness in aged care, however, empirical evidence is lacking.

Methods: A cross‐sectional design was used to collect data from Swedish aged care staff (= 3661). Valid and reliable questionnaires assessing leadership behaviours, person‐centeredness of care and the psychosocial climate were used. Data were analysed using multiple linear regression including interaction terms.

Results: Leadership behaviours were significantly related to the person‐centredness of care and the psychosocial climate. The level of person‐centredness of care moderated the impact of leadership on the psychosocial climate.

Conclusions and implications for nursing management: The leadership behaviour of managers significantly impacts person‐centred care practice and contributes to the psychosocial climate for both staff and residents in aged care. This study is the first empirically to confirm that middle managers have a central leadership role in developing and supporting person‐centred care practice, thereby creating a positive psychosocial climate and high quality care.

Keywords
leadership behaviour, management, nursing homes, person-centred care, psychosocial climate
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-122766 (URN)10.1111/jonm.12380 (DOI)000387215400008 ()27046801 (PubMedID)2-s2.0-84963700024 (Scopus ID)
Available from: 2016-06-22 Created: 2016-06-22 Last updated: 2018-06-07Bibliographically approved
2. Characteristics of highly rated leadership in nursing homes using item response theory
Open this publication in new window or tab >>Characteristics of highly rated leadership in nursing homes using item response theory
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2017 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 12, p. 2903-2913Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
item response theory, leadership, long-term care, management, nursing home care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-143945 (URN)10.1111/jan.13353 (DOI)000418365200012 ()28556986 (PubMedID)
Available from: 2018-01-15 Created: 2018-01-15 Last updated: 2018-06-09Bibliographically approved
3. Leading towards person-centred care – Nursing home managers' experiences of leading person-centred care in highly person-centred Swedish nursing homes
Open this publication in new window or tab >>Leading towards person-centred care – Nursing home managers' experiences of leading person-centred care in highly person-centred Swedish nursing homes
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background:Although a growing body of research knowledge exists highlighting the importance of leadership for person-centred care, studies focused on nursing home managers’ own descriptions of leading their staff to provide person-centred care is lacking. This study aims to explore the process of nursing home managers’ leading person-centred care in Swedish nursing homes.

Methods:The methods of the study consisted of semi-structured interviews with 12 nursing home managers within 11 highly person-centred nursing homes purposively selected from a national wide survey of nursing homes in Sweden. A qualitative content analysis was performed for data analyses.

Results:The study revealed that the leading person-centred care in nursing homes can be outlined as comprising four processes: Embodying person-centred being and doing; promoting a person-centred atmosphere; maximizing person-centred team potential; and finally, optimizing person-centred support structures.

Conclusion:This study contributes to the literature by providing concrete descriptions of how person-centred care can be operationalised and supported in everyday practice by the leadership of nursing home managers. The study is significant in that it provides evidence on how the provision of person centred care can be facilitated by managers and the important role they play in developing and maintaining this philosophy of care within nursing homes.

Keywords
Leadership, Management, Person-centred care, Nursing homes, Qualitative method
National Category
Nursing
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
urn:nbn:se:umu:diva-146495 (URN)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council
Available from: 2018-04-11 Created: 2018-04-11 Last updated: 2018-06-09
4. Job strain in nursing homes: exploring the impact of leadership
Open this publication in new window or tab >>Job strain in nursing homes: exploring the impact of leadership
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed) Epub ahead of print
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.

Keywords
aged care, leadership, long-term care, management, nursing home care, stress, support
National Category
Nursing
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
urn:nbn:se:umu:diva-146494 (URN)10.1111/jocn.14180 (DOI)
Funder
Vårdal FoundationForte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council
Available from: 2018-04-11 Created: 2018-04-11 Last updated: 2018-06-09Bibliographically approved

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