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.

Bereaved Individuals Attempts to Explain Their Unexplainable Experiences Related to the Death of Their Loved one Through Attribution Thinking.

Continuing bond manifesting as unexplainable experiences reflects bereaved´s attempts to restore connection with the deceased. As an experience unaligned with a person's overall schemas of meaning unexplainable experiences are a source of anxiety that individuals aim to alleviate by attribution thinking. This study describes how bereaved aim to explain unexplainable experiences related to the death of their loved ones. The study analysed 408 narratives of 181 bereaved individuals. Bereaved individuals (1) described the meaning of their experience to be receaving information, emotions or support by the experience and communicating about crossing the boundary between life and death. As (2) reflections on the cause of their experiences bereaved individuals described certain and uncertain explanations of the phenomenon, ruling out explanations and the compatibility or incompatibility of the experience with their prior worldviews. The process of attribution thinking must be perceived as meaningful regardless of the outcome of the bereaved person's reflection.

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.

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.

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.

Consequences of Unexplained Experiences in the Context of Bereavement - Qualitative Analysis.

Unexplained experiences are common among bereaved people and are a natural part of grieving, but their consequences may affect their coping with grief. However, professionals lack awareness of these unexplained experiences, which may lead to an unnecessary pathologising of the experiences and a lack of opportunity for the bereaved to process their experiences in a safe environment. The study involved an inductive content analysis of 408 narratives of the consequences of unexplained experiences shared by 181 bereaved individuals. The consequences of the unexplained experiences were: (1) Experiencing after-effects which may alleviate or aggravate wellbeing, as well as be life-affecting; (2) consequences related to sharing or concealing the experiences, and the reactions of others to recounting the experience; (3) documenting the experience through videography, photography and keeping mementos. In conclusion, these experiences have consequences to bereaved which needs to be taken account in support interventions aimed at bereaved individuals.

Finnish nurses' attitudes towards their role in the euthanasia process.

BACKGROUND: Nurses' voices remain unheard in most debates about euthanasia, although their crucial role in the euthanasia process is widely acknowledged. Moreover, in Canadian euthanasia law, nurses have a more active role, which further highlights the need for knowledge about nurses' attitudes towards their role in the euthanasia process. RESEARCH QUESTIONS: What are Finnish nurses' attitudes towards their potential role in the euthanasia process? Which characteristics are associated with those attitudes? RESEARCH DESIGN: Cross-sectional web-based survey. PARTICIPANTS AND RESEARCH CONTEXT: 1003 nurses, recruited via social media and the members' bulletin of the Finnish Nurses Association. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the Committee on Research Ethics of the university to which the first author was affiliated. FINDINGS: The great majority (85.2%) of nurses felt that their perspective should be considered in decision-making related to euthanasia. Furthermore, most of the participants (74.7%) reported willingness to participate in the euthanasia process if it were legal, and 88.6% agreed that a nurse should be present when euthanasia is performed if the patient wishes so. Furthermore, over half agreed that some of the preparatory tasks were part of their job description. However, a minority (32.9%) agreed with a possible obligation to participate based on their profession. Nurses' age, religiosity and educational level influenced their attitudes in the current results. DISCUSSION: Despite the strong agreement on decision-making concerning euthanasia and participation in the euthanasia process, obligation to participate based on the profession was rejected by most participants. Nurses regarded themselves as consultants in the decision-making process, which may indicate their unwillingness to share the responsibility for the decision itself. CONCLUSION: Specific safety mechanisms should be considered to protect nurses who refuse to be involved in the euthanasia process due to harm that involuntary participation might cause.

Nurses' attitudes towards euthanasia in conflict with professional ethical guidelines.

BACKGROUND: Despite the significant role of nurses in end-of-life care, their attitudes towards euthanasia are under-represented both in the current literature and the controversial debate that is ongoing in several countries. RESEARCH QUESTIONS: What are the attitudes towards euthanasia among Finnish nurses? Which characteristics are associated with those attitudes? RESEARCH DESIGN: Cross-sectional web-based survey. Participants and research context: A total of 1003 nurses recruited via the members' bulletin of the Finnish Nurses Association and social media. Ethical considerations: Ethical approval was obtained from the Committee on Research Ethics of the university to which the authors were affiliated. FINDINGS: The majority (74.3%) of the participants would accept euthanasia as part of Finnish healthcare, and 61.8% considered that Finland would benefit from a law permitting euthanasia. Most of the nurses (89.9%) thought that a person must have the right to decide on his or her own death; 77.4% of them considered it likely that they would themselves make a request for euthanasia in certain situations. DISCUSSION: The value of self-determination and the ability to choose the moment and manner of one's death are emphasized in the nurses' attitudes towards euthanasia. CONCLUSION: A continuous dialogue about euthanasia and nurses' shared values is crucial due to the conflict between nurses' attitudes and current ethical guidelines on nursing.

The Traditional Model Does Not Explain Attitudes Toward Euthanasia: A Web-Based Survey of the General Public in Finland.

The debate about euthanasia is ongoing in several countries including Finland. However, there is a lack of information on current attitudes toward euthanasia among general Finnish public. The traditional model for predicting individuals' attitudes to euthanasia is based on their age, gender, educational level, and religiosity. However, a new evaluation of religiosity is needed due to the limited operationalization of this factor in previous studies. This study explores the connections between the factors of the traditional model and the attitudes toward euthanasia among the general public in the Finnish context. The Finnish public's attitudes toward euthanasia have become remarkably more positive over the last decade. Further research is needed on the factors that predict euthanasia attitudes. We suggest two different explanatory models for consideration: one that emphasizes the value of individual autonomy and another that approaches euthanasia from the perspective of fears of death or the process of dying.

Mental well-being, work engagement, and work-related and personal resources among nurse managers: A structural equation model.

Background: Nurse managers are central to guaranteeing quality healthcare outcomes. However, their position is very demanding and special attention should be paid to their mental well-being. Good mental well-being at work is associated with overall occupational well-being, increasing nurse managers' intention to stay in the profession and their commitment to their organization. However, little is known about nurse managers' personal and work-related resources that support good mental well-being. Objective: To explore work-related and personal resources associated with nurse managers' work engagement and mental well-being. Design: A cross-sectional survey study. Participants: Finnish nurse managers (n = 366) including ward managers (n = 332), chief nurses (n = 24), and administrative head nurses (n = 6). Methods: Nationwide online survey data was collected with a self-administered questionnaire in February 2023 from the members of one health and social care workers' trade union. The relationships between nurse managers' personal (psychological capital and calling) and work-related (job resources and social support) resources, work engagement and mental well-being were analysed using structural equation modeling. Nurse managers were also divided into two groups based on their mental well-being score: those with and without depression. The study is reported following the guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Results: Nurse managers who had depression (27%) were associated with less personal and work-related resources compared to managers without depression. Work engagement correlated strongly with mental well-being. A structural equation model that indicated positive significant total effects of work engagement (ß = 0.38), social support (ß = 0.26), job resources (ß = 0.19), and psychological capital ß = 0.28) and calling (ß = 0.13) with mental well-being had an excellent fit. Conclusion: Nurse managers' mental well-being can be supported by organisational strategies and national policies that enhance leadership skills and increase work-related resources, which, in turn, can manifest as psychological and professional capital and a sense of meaningfulness in work.Globally, the healthcare sector needs resilient and healthy nurse managers to respond to current and future challenges. They are key players in safeguarding the well-being and commitment of nursing staff and thereby improving the quality of care.

Urgent hospital transfers - The experiences and required skills of paramedics.

INTRODUCTION: Global changes in the health and social care sector have centralized the treatment of emergency patients, leading to an increase of urgent hospital transfers. The aim of this study is to describe paramedics' experiences gained while working in prehospital emergency care, regarding urgent hospital transfers and the skills that performing urgent hospital transfers requires. METHODS: Twenty paramedics with experience in urgent hospital transfers participated in this qualitative study. The data collected via individual interviews were analyzed using inductive content analysis. RESULTS: Paramedics' experiences of urgent hospital transfers resulted in two upper categories: Factors related to paramedics, and factors related to transfer, conditions, and technology. The upper categories were grouped from six subcategories. Paramedics' experiences of skills required in urgent hospital transfers resulted in two upper categories: Professional competence, and interpersonal skills. The upper categories were grouped from six subcategories. CONCLUSIONS: Organizations should support and promote training related to urgent hospital transfers to enhance the quality of care and patient safety. Paramedics play a key role in successful transfer and collaboration, and thus the required professional competences and interpersonal skills should be addressed in their education. Furthermore, developing standardized procedures is recommended to enhance patient safety.

Nurse leaders' experiences of remote leadership in health care.

PURPOSE: This study aimed to describe nurse leaders' experiences of remote leadership in health care sector. DESIGN/METHODOLOGY/APPROACH: Semistructured interviews were conducted among nurse leaders (N = 12) between January and March 2022. All of the interviewees had experiences of remote leadership and worked as immediate - (n = 5) or middle-level (n = 7) leaders in health care organizations across four provinces in Finland. The collected data were analyzed by inductive content analysis. FINDINGS: The leaders had experienced a rapid transition to remote leadership and highlighted the need for guidelines and joint discussions with different stakeholders. The interviewees felt that working life has changed in the last two years and that remote leadership will now be a key part of leadership in health care. The leaders' experiences highlighted how important trust is in remote leadership. Furthermore, the interviewees pointed out a need for face-to-face contact and described other good practices for remote leadership. Overseeing work-related well-being was also stressed as important in the remote context; however, the interviewees expressed a need for instructions and tools concerning the management of employee well-being. The sudden change to remote leadership was not only described as interesting but also challenging, which has affected the leaders' work-related well-being. Support - both from the organization and other employees - was found to be crucial to health care leaders' work-related well-being. ORIGINALITY/VALUE: The current study complements the little-researched topic of remote leadership in the health care sector. The results provide insights that can be used to develop remote leadership and/or guide future research.

Humane and Comprehensive Management of Challenging Behaviour in Health and Social Care: Cross-Sectional Study Testing Newly Developed Instrument.

BACKGROUND: Management of challenging behaviour causes victimization and violates the human rights of service users in psychiatric and long-term settings for people having mental health issues and learning disabilities. The purpose of the research was to develop and test an instrument for measuring humane behaviour management (HCMCB). The research was guided by the following questions: (1) What is the structure and content of the Human and Comprehensive management of Challenging Behaviour (HCMCB) instrument, (2) What are the psychometric properties of the HCMCB instrument, and (3) How do Finnish health and social care professionals evaluate their humane and comprehensive management of challenging behaviour? METHODS: A cross-sectional study design and STROBE checklist were applied. A convenience sample of health and social care professionals (n = 233) studying at the University of Applied Sciences (n = 13) was recruited. RESULTS: The EFA revealed a 14-factor structure and included a total of 63 items. The Cronbach's alpha values for factors varied from 0.535 to 0.939. The participants rated their individual competence higher than leadership and organizational culture. CONCLUSIONS: HCMCB is a useful tool for evaluating competencies, leadership, and organizational practices in the context of challenging behaviour. HCMCB should be further tested in various international contexts involving challenging behaviour with large samples and longitudinal design.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study.

BACKGROUND: This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment. METHOD: A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically. RESULTS: A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point. CONCLUSION: Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

Relationships between nursing leadership and organizational, staff and patient outcomes: A systematic review of reviews.

AIM: To assess and describe reviews of nursing leadership styles associated with organizational, staff and patient outcomes. DESIGN: A systematic review of reviews. METHODS: Reviews describing a search strategy and quality assessment. The review followed the PRISMA statement. Nine databases were searched in February 2022. RESULTS: After screening 6992 records, 12 reviews were included reporting 85 outcomes for 17 relational, nine task-oriented, five passive and five destructive leadership styles. Transformational leadership, which is one of the relational styles, was the most studied among all the styles. Of the outcomes, staff outcomes were the most reported, notably job satisfaction, and patient outcomes were less reported. Also, mediating factors between relational leadership styles and staff and patient outcomes were identified. CONCLUSION: Extensive research shows the beneficial impacts of relational leadership; however, destructive leadership research is lacking. Relational leadership styles should be conceptually assessed. More research is needed on how nurse leadership affects patients and organizations.

A comprehensive evaluation of factors affecting nurse leaders' work-related well-being.

PURPOSE: This study aims to describe nurse leaders' experiences of work-related well-being and its association with background variables, working conditions, work engagement, sense of coherence and burnout. DESIGN/METHODOLOGY/APPROACH: An electronic survey design was used. Data was collected between December 2015 and May 2016 with an instrument that included demographic questions and four internationally validated scales: the Utrecht Work Engagement Scale, QPS Nordic 34+, the shortened Sense of Coherence scale and the Maslach Burnout Inventory. Data was analysed using statistical methods. FINDINGS: A total of 155 nurse leaders completed the questionnaire, giving a 44% response rate. Most of them worked as nurse managers (89%). Participants' work-related well-being scores ranged from 8 to 10. Statistically significant relationships were found between participants' work-related well-being and their leadership skills, current position, sense of coherence and levels of burnout. In addition, there were statistically significant relationships between work-related well-being and all dimensions of working conditions. ORIGINALITY/VALUE: This study underlines the fact that work-related well-being should not be evaluated based on a single factor. The participants' perceived work-related well-being was high, although almost half of them reported always or often experiencing stress. The results suggest that nurse leaders may have resources such as good leadership and problem-solving skills, supportive working conditions and a high sense of coherence that prevent the experienced stress from adversely affecting their work-related well-being.

Structural and psychological empowerment of students obtaining continuing leadership education in Finland-a national survey.

BACKGROUND: In nursing, empowerment may be deemed one's potential to gain power, achieve goals and promote one's skills to advance positive changes in the working environment, or decentralization of authority. Empowerment is associated with nurses' and nurse leaders' satisfaction, performance and organizational commitment, as well as burnout, emotional exhaustion and intentions to leave the profession. Research on nurse empowerment in relation to continuing education is sparse. OBJECTIVES: This study describes the structural and psychological empowerment levels of students beginning a collaboratively implemented continuing leadership education program. DESIGN: Cross-sectional electronic survey. SETTINGS: National, continuing nursing leadership education program (37 ECT) organized by five universities that provide masters level education to nurse leaders in Finland. PARTICIPANTS: Students (N = 85) working at nine healthcare organizations across the service system as current or prospective nurse leaders and enrolled in the continuing leadership education program. METHODS: The Conditions of Work Effectiveness Questionnaire and the Work Empowerment Questionnaire were each used to measure structural and psychological empowerment, respectively. The data were collected between October 2019 and February 2020. RESULTS: A total of 69 students participated (response rate 81 %). Moderate levels of both structural and psychological empowerment were observed. In structural empowerment, the strongest dimension was access to opportunity (4.1, SD 0.7), whereas access to support was the weakest (2.7, SD 0.7). The strongest psychological empowerment dimension was verbal empowerment (8.5, SD 1.9) and the weakest was outcome empowerment (7.0, SD 1.6). CONCLUSIONS: Nurses and nurse leaders seem to lack the status and power required to impact their organizations, possibly causing them to apply for nursing leadership education. Nurse leaders should be given opportunities for continuing leadership education to improve empowerment and, as a result, staff outcomes.

Attitudes of Nurses and the General Public Towards Euthanasia on Individuals with Dementia and Cognitive Impairment.

OBJECTIVES: Despite the increasing prevalence of dementia, little is known about individuals' attitudes towards euthanasia on patients with dementia or cognitive impairment. METHODS: Nurses (n = 1003) and representatives of the general public (n = 2796), recruited via social media and the Finnish Nurses Association, completed an electronic questionnaire in 2014. RESULTS: Euthanasia due to severe dementia was approved by 54.6% of nurses and 64.4% of the general public. Depending on the age of the patient, between 50.0% and 54.7% of nurses and between 58.3% and 60.9% of the general public supported euthanasia on patients with severe cognitive impairment. DISCUSSION: The attitudes towards euthanasia due to dementia or cognitive impairment are slightly more accepting among the general public than among nurses. Apart from religiosity, none of the background factors were found to be reliable predictors of individuals' attitudes. Additional research is needed to describe the underlying reasons for the attitudes.