Measuring trust in healthcare with instruments developed in different disciplines - A scoping review.

BACKGROUND: Trust is a key character at organizational level. Understanding the level of trust with timely relevant instrument is a significant process to capture the level of trust beyond organizational changes in healthcare. OBJECTIVES: To gather, assess, and synthesize the items of instruments evaluating trust in healthcare organizations. DESIGN: Scoping review methodology. METHODS: The literature search with deductive-inductive content analysis. The data were charted from articles that involved the use of trust instruments in healthcare organizations. DATA SOURCES: Search from eight databases was updated in January 2024 and included peer-reviewed articles published between 2010 and 2023. RESULTS: A total of 13 instruments were found measuring trust in the organization, trust in the leader, and trust among peers in healthcare. The items of instruments about trust in the organization included strategic and operational cultures. The trust in the leader consisted of competence, consistency, openness, appreciative acceptance, and loyalty and risk, while instruments about trust among peers included dimensions of moral partnership, common interest, and competent peers. CONCLUSIONS: Comprehensively measuring trust in the leader, trust in the organization, and trust among peers is significant due to the multifaceted dimension of trust. Measuring trust offers a possibility to recognize the working relationships and cultures in healthcare organizations.

Prioritization decision-making of care in nursing homes: A qualitative study.

BACKGROUND: Prioritization decision-making arises when nurses encounter intricate situations that demand ethically challenging judgments about care. This phenomenon has rarely been studied in nursing homes. Prioritization decision-making may lead to instances where individuals in social and healthcare may not receive all services they need. Making prioritization decisions and awareness of their consequences can increase nurses' workload. AIM: To describe prioritization decision-making regarding unfinished nursing care in nursing homes. RESEARCH DESIGN: A qualitative descriptive study conducted through individual theme interviews. Participants were recruited through social media. The data was analyzed using inductive content analysis. PARTICIPANTS AND RESEARCH CONTEXT: Nurses (n = 23) working in nursing homes for the elderly people in Finland. Data were collected between June 2022 and February 2023. ETHICAL CONSIDERATIONS: Finnish legislation does not mandate an ethical review or research permits, as the participants took part as private individuals. [ask authors to make reference here to informed consent process and anonymity]. FINDINGS: Nurses stated that the need for prioritization decision-making arises from challenges associated with nurses' engagement with person-centered care, the culture of the work community, the burden due to workload and challenges associated with the leadership. Prioritization decision-making was based on the interests of residents, striving for an efficient workflow and nurse's personal interests. Nurses did not receive support for decision-making regarding unfinished care, and protocols for prioritization had not been established in their work communities. Prioritization decision-making and unfinished care were concealed and left unspoken. CONCLUSION: Nursing leaders should address this hidden phenomenon, making it visible through discussions with nurses and by involving them in the development of protocols. The findings can be utilized for developing new approaches to support nurses and reduce their workload and for enhancing the quality and person-centeredness of nursing care in nursing homes.

The multifaceted nature of risk behaviour among adolescents-A document analysis of patient and aftercare service providers' records.

AIM: The aim of this study was to describe the forms and the prevalence of risk behaviour among adolescents in aftercare services, as well as identify the associated factors and use of services by adolescents. BACKGROUND: Adolescents in aftercare services represent a vulnerable group that struggles with several aspects of life. The challenges they face are known to accumulate in certain individuals, and the problems that are relevant for this group tend to have an intergenerational nature. DESIGN: The research applied retrospective document analysis, with the analysed data comprising information on 698 adolescents in aftercare services in one large Finnish city from the fall of 2020. METHODS: The data were analysed using descriptive statistics and multivariate methods. RESULTS: Risk behaviour was identified among 616 of the studied adolescents (88.3%), and manifested as substance abuse, reckless sexual behaviour and/or use of money, nicotine use, self-destructive behaviour, delinquency and functional dependencies. Regarding the associations between risk behaviour and background variables, an adolescents' child's clientship in child protection or the child's placement in foster care, adolescent's need for support in parenting, problems with daily rhythm and problems with studying were found to influence the prevalence of risk behaviour. Forms of risk behaviour were also found to be associated with each other. Adolescents displaying risk behaviour commonly did not use the social counsellor, psychiatric outpatient care and study counselling services, even if they would have needed them. CONCLUSIONS: The interconnections between different forms of risk behaviour mean that this issue should be prioritized when developing aftercare services. IMPACT: This is the first time that risk behaviour among adolescents in aftercare services has been comprehensively examined. Understanding this phenomenon is key to identifying future research topics, guiding decision-making and helping stakeholders truly understand the needs of these adolescents. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution as the study was based on a document analysis.

Violence by clients and patients against social and healthcare staff - An integrative review of staff's well-being at work, implementation of work and leaders' activities.

AIM: The aim of this study was to compile, assess and synthesise empirical research on violence by social and healthcare clients or patients against staff and its connections to staff's well-being at work, implementation of work and activities of leaders related to it. BACKGROUND: Workplace violence against social and healthcare staff is a global and daily problem. One in three employees encounters violence from patients or clients and the risk of this is 16 times higher compared to other professions. None of the recent reviews on this topic were focused on the well-being at work, implementation of work or leaders' role in the cases of violence of clients or patients against the staff. DESIGN: An integrative review reported according to PRISMA Checklist. METHODS: The search was conducted to CINAHL, PubMed, PsychINFO and Scopus databases resulting in 21 articles. The quality of the articles was evaluated, and the data were analysed narratively. RESULTS: The workplace violence committed by clients and patients was negatively connected to staff's psychological, emotional and physical well-being at work and to their work performance and commitment. The leaders found this form of workplace violence challenging and ethically conflicted and felt that they were left alone without training and support. The employees expressed disappointment with their leaders' activities and suggested many measures to make environment safer to staff and patients. CONCLUSIONS: In future, intervention studies are needed for prevention of workplace violence by patients and clients against staff and for supporting the well-being at work of staff in relation to violent incidents. RELEVANCE TO CLINICAL PRACTICE: Workplaces should introduce uniform protocols for reporting, preventing and processing workplace violence committed by clients and patients. An open dialogue with leaders and co-workers of the cases is of high importance. Leaders and staff need training that ensure patient and work safety.

Nurses' substance use disorder in disciplinary procedures: A retrospective document analysis.

AIM AND OBJECTIVES: To describe nurses with substance use disorder (SUD) in authority disciplinary actions. BACKGROUND: Nurses with SUD risk patient safety. Research evidence on the identification of nurses' SUD and related management procedures is currently sparse. DESIGN: Retrospective document analysis of decisions related to SUD in nurses' disciplinary actions. METHOD: Decisions on nurses (N = 171) made by the Finnish National Supervisory Authority for Welfare and Health in Finland during 2007-2016 were used as data. An electronic extraction sheet was developed for data collection including variables (N = 34), of which 18 were analysed in this study with descriptive statistical methods and chi-squared statistics. The study reported in accordance with the STROBE checklist for cross-sectional studies. RESULTS: The mean age of the nurses was 43 years (SD 8.7). The most mentioned reasons for notifications leading to disciplinary actions were substance abuse with working while intoxicated and drug theft. The most mentioned intoxicants used were medicines and alcohol. On average, the first disciplinary decision was given at 6.4 months (SD 3.9) and the final decision was given at 17.9 months (SD 13.1). The most common decision was restriction of the right to practice. CONCLUSION: The results supported findings from previous decades and different continents, showing similar trends are prevalent globally and continue today. In future studies, countries' registers of nurses with SUD could be used to clarify the profile of nurses and develop appropriate procedures. Qualitative studies could be conducted to investigate to shed light on concealment of the phenomenon. RELEVANCE TO CLINICAL PRACTICE: There is a need for early identification, intervention and referral to treatment as well as effective protocols for reducing nurses' risks of disciplinary actions related to SUD. It is important to be aware of the signs and symptoms of SUD and training for this is needed.

Unfinished nursing care in nursing homes.

This study aimed to describe unfinished nursing care activities in nursing homes. The study was conducted as a cross-sectional survey and employed the BERNCA-NH-instrument and one open-ended question. The participants were care workers (n=486) in nursing homes. The results showed that an average of 7.3 nursing care activities out of 20 were unfinished. A large share of the unfinished activities were related to residents' social care and the documentation of care. Female gender, age, and the amount of professional experience were found to increase the likelihood of unfinished nursing care. The unfinished care was the result of insufficient resources, residents' characteristics, unexpected situations, non-nursing activities, and challenges in organizing and leading care. The results indicate that all of the necessary care activities are not performed in nursing homes. Unfinished nursing activities might affect residents' quality of life and diminish the visibility of nursing care. Nursing home leaders have a significant role to play in decreasing unfinished care. Future research should address how to reduce and prevent unfinished nursing care.

Health and social care workers' professional values: A cross-sectional study.

BACKGROUND: Professional values create a basis for successful collaboration and person-centred care in integrated care and services. Little is known about how different health and social care workers assess their professional values. RESEARCH AIM: To describe and compare professional value orientation among different health and social care workers in Finland. RESEARCH DESIGN: A quantitative cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT: We carried out an online survey of health and social care workers from 8 March to 31 May 2022, using the Finnish version of the Nurses' Professional Values Scale-3. The data were analysed using descriptive and advanced statistics. ETHICAL CONSIDERATIONS: Permission was received from all participating organizations and those who completed the survey provided informed consent. RESULTS: A total of 1823 health and social care workers, representing seven professional groups and students, took part. The overall level of professional values among the participants was relatively high. Commitment to providing patients and clients with equal care was more important than engaging with society and professional responsibilities in the work environment. Professional values were strongest among professionals with higher educational degrees and training in professional ethics. The same was true for workers who received organizational support for ethical practice, were satisfied with their work and had shorter work experience. DISCUSSION: Our results showed shared professional values among different health and social care workers and students. These results are meaningful for integrated care and services. At the same time, a clear need for strengthening engagement with society and professional responsibilities for developing work environments were identified. CONCLUSIONS: Health and social care workers and students need training in professional ethics and organizational support for ethical practice and work satisfaction to maintain their professional values at different stages of their career.

Towards remote leadership in health care: Lessons learned from an integrative review.

AIM: To gather and synthesize current empirical evidence on remote leadership and to provide knowledge that can be used to develop successful remote leadership in health care. DESIGN: A integrative literature review with an integrated mixed methods design. DATA SOURCES: The literature search was carried out between February and March 2019 in the CINAHL, Medline (Ovid), PsycInfo, Scopus, SocIndex, Web of Science and Business Source Elite (EBSCO) databases. REVIEW METHODS: An integrative review was conducted to identify relevant studies published from 2010 to 2019. Of the 88 eligible studies, 21 studies met the inclusion criteria and were selected for the final review. The included studies were analysed using mixed methods synthesis, more specifically, data-based convergent synthesis. RESULTS: The performed analysis identified three main themes: characteristics of successful remote leadership; enhancing the leader-member relationship; and challenges in remote leadership. The first theme included the following sub-themes: remote leader characteristics; trust; communication; and leading the team culture. The second theme covered the importance of organizing regular face-to-face meetings, clear communication policies and the connection between positive team spirit and good remote leader-member relationship, while the third theme emphasized leader- and member-related challenges for remote work. CONCLUSIONS: As none of the identified studies had been conducted in a health care setting, future remote leadership research must also specifically consider the health care context. This will be pivotal to exploring how remote work can foster a safe workplace culture, empower health care workers, increase job satisfaction and improve patient outcomes. IMPACT: Remote leadership has rarely been studied in the health care context. Trust, communication, team spirit and a leader's characteristics are central to remote leadership, a finding which is useful for re-evaluating and improving the current culture at health care organizations.

A systematic review of the relationships between nurse leaders' leadership styles and nurses' work-related well-being.

AIM: This systematic review aimed to summarize current research knowledge about the relationships between nurse leaders' leadership styles and nurses' work-related well-being. BACKGROUND: Due to the global shortage of nurses, it is essential for nurse leaders to maximize staff retention and work-related well-being. METHODS: Following Cochrane Collaboration procedures, the PRISMA statement and PRISMA checklist, relevant quantitative studies published between 1 January 2012 and 31 December 2020 were retrieved from the CINAHL, Scopus, PubMed and Medic databases and then systematically reviewed. Seventeen cross-sectional and follow-up studies with surveys were retained for inclusion and evaluated with the Critical Appraisal of a Survey instrument. The data were summarized narratively. RESULTS: Three core themes of leadership styles: destructive, supportive and relationally focused, were identified, with statistically significant direct and indirect connections between nurses' work-related well-being. Well-being was mainly assessed in terms of burnout. Effects of leadership styles on work-related well-being were reportedly mediated by trust in leader, trust in organization, empowerment, work-life conflict, relational social capital, emotional exhaustion, affectivity, job satisfaction and motivation. CONCLUSION: Nurse leaders' leadership styles affect nurses' work-related well-being. In developing intervention studies and providing training on work-related well-being, the impact of the indirect effects and the mediating factors of the leadership styles should be acknowledged.

Professional governance in Finnish nursing - measured by the Index of Professional Nursing Governance.

AIM: To translate and validate the Index of Professional Nursing Governance (IPNG) 2.0 and assess the state of professional nursing governance in Finland. BACKGROUND: Raising and maintaining quality of care while retaining staff are common problems in healthcare globally. Professional governance is a modern way to tackle them, but a reliable instrument is needed to measure the state of nursing governance in Finland, and elsewhere. METHODS: The IPNG that was translated into Finnish by forward-backward translation, culturally adapted and pilot tested with 20 nurses. A sample of 419 nurses was utilised in a cross-sectional study to assess the state of professional governance in Finland 2018. RESULTS: Principal component analysis yielded six components with good Cronbach's α values. The results clearly indicate that the IPNG version developed and evaluated in this study has suitable psychometric properties for use in Finnish healthcare settings. The validated IPNG scores indicate that nursing governance in Finland is in the professional governance range. The staff have some input in the governance of Finnish healthcare organisations. However, this perception is strongest among the nurse leaders and experts; other groups do not perceive much change yet. CONCLUSION: Participants, particularly nurse leaders in Finland, had self-reported impact in decision-making. The translated IPNG has acceptable internal consistency and can be used to assess healthcare organisations' governance models in Finland and broader in Nordic countries and Europe.

Ethical issues identified in nurses´ interprofessional collaboration in clinical practice: a meta-synthesis.

The aim of this study was to synthesize previous knowledge about ethics in nurses' interprofessional collaboration in clinical practice. Although healthcare professionals have common goals and shared values, ethical conflicts still arise during patient care. We carried out a meta-synthesis of peer-reviewed papers published in any language from 2013-2019, using both electronic searches, with the CINAHL, PubMed, Scopus, and SocINDEX databases, and manual searches. We identified 4,763 papers and selected six qualitative papers, and three theoretical papers, based on predetermined inclusion and exclusion criteria and quality appraisal. The studies came from the USA, Canada, Sweden, Australia, Botswana, and the Netherlands. We found that in ethics studies on nurses' interprofessional collaboration in clinical practice the focus has been on factors that affect how patients receive care. These factors were patients' wishes, whether they were told the truth about their condition, and how different professionals recognized and treated their pain. The focus in the papers we reviewed was on the roles of different professionals during the care process, including ethical conflicts with regard to their aims, commitment, and the balance of power among them and other professions. More research is needed to raise the visibility of how nurses and other professionals recognize, and evaluate, their professional and interprofessional ethics.

Unprofessional conduct by nurses: A document analysis of disciplinary decisions.

BACKGROUND: A small minority of nurses are investigated when they fail to meet the required professional standards. Unprofessional conduct does not just affect the nurse but also patients, colleagues and managers. However, it has not been clearly defined. OBJECTIVE: The objective was to identify unprofessional conduct by registered nurses by examining disciplinary decisions by a national regulator. DESIGN: A retrospective document analysis. DATA AND RESEARCH CONTEXT: Disciplinary decisions delivered to 204 registered nurses by the Finnish national regulatory authority from 2007 to 2016. The data were analysed with quantitative statistics. ETHICAL CONSIDERATION: The study received permission from the Finnish National Supervisory Authority for Welfare and Health and used confidential documents that were supplied on the basis of complete anonymity and confidentiality. FINDINGS: The mean age of the registered nurses who were disciplined was 44 years and 81% were female. Two-thirds had worked for their employer for 5 years or less, 53% had two or more employers and 18% had a criminal history. All the decisions included a primary reason for why the nurses were investigated, but there were also 479 coexisting reasons. In most cases, unprofessional conduct was connected to substance abuse (96%). In addition, stealing of medicine, a decreased ability to work and neglect of nursing guidelines were reported. DISCUSSION: We found that the nurses were investigated for unprofessional conduct for complex combinations of primary and coexisting reasons. Our study highlighted that more attention needs to be paid to the key markers for unprofessional conduct. CONCLUSION: Unprofessional conduct is a complex phenomenon that is connected to nurses' individual and working backgrounds and has an impact on their work performance. More research is needed to identify how nursing communities can detect, manage and limit the serious effects and consequences of unprofessional conduct.

Nurses' critical reflections of working in unit practice councils-A qualitative interview study.

AIM: This study aimed to describe nurses' experiences of working as members of unit practice councils. BACKGROUND: Health care organisations worldwide want personnel to participate in decision-making. Unit practice councils promote unit-level decision-making over unit-specific issues. Despite extensive research on shared decision-making, few studies have examined the experiences of nurses serving as members of these councils. METHODS: A descriptive qualitative study design was used with semi-structured interviews of 16 nurses in two clinics of a Finnish university hospital. Interviews were analysed using thematic analysis. RESULTS: The analysis revealed two themes describing nurses' experiences as members of unit practice councils: (i) inchoate unit practice councils with insufficient allocated working time and (ii) partial empowerment of nurses through the organisation's evolving Magnet project. CONCLUSIONS: Unit practice councils in the studied organisations are inchoate and unable to effectively advance shared decision-making or support nurses' professional autonomy. In the future, the councils require constant support from all leadership levels of the organisation. IMPLICATIONS FOR NURSING MANAGEMENT: Sharing decision-making power could be a win-win situation where nurse leaders relinquishing power over certain matters gain time to immerse in wider issues. While acknowledging different organisational roles, there is room for trusting each other's professionality and respecting autonomous work.

Disciplinary processes for nurses, from organizational supervision to outcomes: A document analysis of a regulatory authority's decisions.

AIM: This study aims to explore the disciplinary processes for nurses, from organizational supervision to final decisions by the Finnish regulatory authority. BACKGROUND: Regulatory authorities are responsible for protecting the public, by ensuring that they receive safe, competent and ethical nursing care, but little is known about the disciplinary processes for nurses. METHODS: This is a retrospective document analysis of 296 disciplinary decisions by the Finnish regulatory authority from 2007 to 2016. The data were analysed using a quantitative design with descriptive statistics. RESULTS: We studied 204 disciplined nurses (81.4% female) with a mean age of 43.5 years. The disciplinary process comprised organizational supervision, complaints, investigations and decisions. Nurses with substance abuse issues were more likely to face criminal investigations and receive temporary decisions. The process lasted from under 1 month to years and could have profound effects on nurses, colleagues and nurse managers and compromise patient safety. CONCLUSION: This study identified key factors that could inform the disciplinary processes for nurses. More knowledge is needed about how organisations ensure patient safety when unprofessional conduct is suspected. IMPLICATIONS FOR NURSING MANAGEMENT: Retaining nursing professionals is vital due to global shortages, and more attention should be paid to organizational supervision and support for nurses during disciplinary processes.

Nurse leaders' work-related well-being-Relationships to a superior's transformational leadership style and structural empowerment.

AIMS: To describe how nurse leaders' work-related well-being is related to a superior's transformational leadership style and structural empowerment. BACKGROUND: The demanding role of nurse leader means that these professionals experience emotional exhaustion and challenges with work-life balance. They can also be influenced by the leadership style of their own superiors. METHODS: A cross-sectional questionnaire using two internationally validated scales, namely, the Transformational Leadership Scale and Conditions For Work Effectiveness Questionnaire-II, was used. Statistical methods were applied during data analysis. RESULTS: A total of 155 nurse leaders participated completed the questionnaire. The participants' work-related well-being scores ranged from 8 to 10. The participants felt that their superiors employ transformational leadership. The dimension of feedback and rewards received the lowest scores, whereas the nurse leaders reported moderate overall empowerment levels. A nurse leader's work-related well-being was positively correlated with structural empowerment and their superior's leadership style. CONCLUSIONS: Despite the fact that nurse leaders reported relatively high levels of work-related well-being, more attention should be paid on the feedback and rewards and on the support of superiors as they positively influence the work-related well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Transformational leadership should be supported in organisations and through education as it strengthens work-related well-being and structural empowerment of nurse leaders.

An integrative review on interventions for strengthening professional governance in nursing.

AIM: To identify the interventions for strengthening professional nursing governance and describe their outcomes. BACKGROUND: The ever-changing health care environment requires empowering governance structures and shared decision-making. The costly nature of reshaping governance makes the identification of effective interventions vital. EVALUATION: An integrative review was carried out between January 2007 and May 2020 in the CINAHL, PubMed, Scopus, PsycINFO, Business source, Cochrane and Medic databases. The quality of the 12 included studies was evaluated with the Joanna Briggs Institute critical appraisal tools. KEY ISSUES: Eight studies reported that the implemented interventions had positively influenced organisation regarding creating positive work environments, building new leadership competencies and increasing personnel's ability to take part in decision-making. The overall quality of the evidence was judged to be moderate. CONCLUSION: Comprehensive decision-making structures, efficient teamwork and transformational leadership competencies among nurse leaders enable personnel to participate in decision-making. Further research is needed to identify the most effective interventions for improving professional governance. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders have to ensure that personnel have adequate opportunities to congregate and decide over matters concerning their work. Positive organisational climate and relational leadership style, along with highly functioning teams, are important prerequisites to nursing councils producing the desired outcomes.

Integrative review of the evaluation of additional support programs for care leavers making the transition to adulthood.

PROBLEM: Care leavers face many challenges during their transition to adulthood, such as educational attainment, financial instability, housing problems and relationship problems. Various structured programs and additional support exist to help them make this transition and these provide help before or after they have left care. However, the outcomes of such support programs are fragmented. The aim of this study was to synthesize the empirical evidence of studies that evaluated additional support programs that facilitated the transition of care leavers to adulthood. ELIGIBILITY CRITERIA: Six databases were searched that were published in English in peer-review journals from 2010 to 2019. We reviewed 16 studies related to additional support programs with different methodological designs. SAMPLE: Care leavers' who have left the foster care. RESULTS: There were two different types of programs: single-focused and multiple-focused programs. Half of them provided holistic support. Feedback from care leavers provided practical suggestions for the development of relationships with the staffs and peers, for the development of programs and care leavers own involvement in decision-making. The evaluations showed weak evidence of the effectiveness of housing, employment and educational programs. CONCLUSIONS: The programs were poorly described and heterogenous so that the outcomes could not be compared. It was not possible to provide robust information about their effectiveness. IMPLICATIONS: We need holistic programs which consider care leavers needs and views, and evaluate rigorously the programs by strong study designs, to determine their effectiveness.

Do Aftercare Services Take Young People's Health Behaviour into Consideration? A Retrospective Document Analysis from Finland.

BACKGROUND: Health disparities among children and young people predict health disparities in adulthood and cause a long-term detrimental impact on a person's quality of life as well as increased costs to society. PURPOSE: The purpose of the study was to describe the health behaviour of Finnish young people (n = 600) who had left aftercare services by the end of April 2015 based on their electronic patient records. DESIGN AND METHODS: A retrospective document analysis. Data were collected from the register by a structured worksheet designed for this study and analysed using descriptive statistical methods. RESULTS: The entries made in the aftercare participants' records concerning their weight, sleep and rest, smoking and sexual health were insufficient. The documents contained clearly more detailed reports of their substance use. Women were affected more than men by lifestyles other than substance abuse endangering their health. An increase in the number of out-of-home care placements produces a spike in risky behaviour. CONCLUSIONS: The young people in aftercare are in an unequal position compared to the mainstream population in the area of health promotion. Their risky behaviour is not identified or taken into consideration. PRACTICE IMPLICATIONS: Aftercare and the related multiprofessional collaboration must be developed to prevent risks related to the young persons` health and to take these comprehensively into account.

Transformative agency and tensions in knowledge management-A qualitative interview study for nurse leaders.

AIM: To describe Finnish nurse leaders' perceptions of and experiences with knowledge management. BACKGROUND: Health science research has traditionally focused on knowledge transfer and research evidence instead of knowledge management, culture and organisational learning. Systematic reviews indicate a lack of awareness about nurse leaders' activities in knowledge management. DESIGN: Qualitative interview study according to the consolidated criteria for reporting qualitative research (see Supporting Information Table S1). METHODS: Data were collected at a Finnish public, social and healthcare organisation from 33 persons in 2015 and 2017 through 35 individual interviews and seven focus groups. Data were analysed by thematic analysis. RESULTS: Nurse leaders' daily knowledge management activities included assurance of smooth work functions and decisions about sudden changes. When managing knowledge promotion, nurse leaders focused on the near future and served information providers, coaches and developers of operating culture. Anticipatory management of knowledge requirements emphasised nurse leaders' roles as assessors and visionaries. Tensions while managing knowledge were related to the following: changes in clients' service needs, insufficient structures and tools to support the assessment and joint development of competence, time and information management, the operating culture, and nurse leader support. Participants reported only few attempts to solve tensions and therefore little to no transformative agency. CONCLUSION: Nurse leaders prioritised daily knowledge management over management of knowledge promotion and anticipatory management of knowledge requirements. Knowledge management in nursing is a complex task requiring a command of different kinds of agency and related leadership styles. The structures, processes and tools supporting knowledge management should be developed to ensure that activities are systematic. RELEVANCE TO CLINICAL PRACTICE: A description of nurse leaders' perceptions of and experiences with knowledge management could improve recognition of nurse leaders' agencies for knowledge management, identification of related tensions and application of lessons learned from tensions. This description could also promote nurses' professional competence and supplement nurse leaders' training.

Integrative review of studies about nurses who have been disciplined by their professional regulatory bodies.

AIM: To synthesize knowledge in studies about nurses who had been disciplined by their professional regulatory bodies. BACKGROUND: Unprofessional conduct that violates patient safety, nursing standards or legislation can result in disciplinary action that affects nurse's professional rights to practice. However, research on disciplinary procedures in nursing is fragmented. METHODS: An integrative review was carried out with systematic searches between January 2006 and November 2018, using the CINAHL, PubMed, Scopus and Web of Science databases and manual searches. The quality of the 17 included studies was evaluated with the Mixed Method Appraisal Tool. RESULTS: The evidence in the included studies focused on various databases. Disciplined nurses were described in relation to their characteristics and disciplined because of numerous patients, practice and behaviour related violations. Similar disciplinary actions against nurses were reported. CONCLUSION: This review provides knowledge on contributory risk factors that can be used to develop professional standards and early interventions in nursing management. More systematic research is needed, together with clear definitions of disciplinary procedures. IMPLICATION FOR NURSING MANAGEMENT: This knowledge could strengthen the abilities of nurse managers to recognize and prevent events that seldom occur but seriously threaten the safety of patients and nurses when they do.