Organisational and leadership skills towards healthy workplaces: an interview study with registered nurses in Sweden.

BACKGROUND: According to shortage of registered nurses, organisational and leadership aspects grounded in person-centrered approach, are highlighted to ensure high quality of care. Therefore, it is interesting to develop knowledge regarding registered nurses working environment. AIM: The aim of the study was to investigate registered nurses' reason to end their employment at a university hospital setting (internal medicine, emergency department). METHOD: Qualitative content analysis with an inductive methodological approach was used to analyse registered nurses' experiences regarding their former employment. Inclusion criteria; all nurses (n = 55) who ended employment during one year (first of July 2020-30th of June 2021) were invited, and 38 semi-structured interviews were conducted. RESULTS: Three categories were identified: Limited organisational support, Lack of visible leadership, and Limited healthy working environment, followed by six subcategories: Longing for organisational support, Being a tile in a box, Need for professional relationship, Limitation of supportive leadership, Imbalance of work versus personal life, and Ethical stress. CONCLUSION: To improve registered nurses working environment and commitment to work, balance between time at work and personal life is significant. Therefore, organisational support and leadership skills grounded in a person-centred approach are crucial to develop a healthy working environment. A person-centred leadership could improve collaboration and shared decision-making in partnership with those involved, managers, nurses, and team members.

Documentation of pressure ulcers in medical records at an internal medicine ward in university hospital in western Sweden.

OBJECTIVES: Pressure ulcers cause suffering, prolong care periods, and increase mortality. The aim was to describe and analyze the documentation of pressure ulcers and focused on the medical records from an internal medicine ward in a university hospital in western Sweden. METHODS: A quantitative, retrospective review of medical records was conducted for all care events (n = 1,458) with descriptive statistics. RESULTS: Documentation of the pressure ulcers in care plans was 2.1% (n = 31) compared to 6.7 % (n = 46) within final notes written by registered nurses (RN), a lower result compared to PPM (n = 3/14, 21.4%). Risk assessments were carried out in 68 (4.7%) care events, and 31 care plans included pressure ulcers. Moreover, 198 cases of tissue damage were documented, 43 (21.7%) defined as pressure ulcers, the other 147 (74.2%) lacked definition. CONCLUSIONS: Differences (2.1%-21.4%) highlight improvements; knowledge and communication of pressure ulcers ensure reliable documentation in medical records.

Diffusion of person-centred care within 27 European countries - interviews with managers, officials, and researchers at the micro, meso, and macro levels.

PURPOSE: This study aimed to describe facilitators and barriers in terms of regulation and financing of healthcare due to the implementation and use of person-centred care (PCC). DESIGN/METHODOLOGY/APPROACH: A qualitative design was adopted, using interviews at three different levels: micro = hospital ward, meso = hospital management, and macro = national board/research. Inclusion criteria were staff working in healthcare as first line managers, hospital managers, and officials/researchers on national healthcare systems, such as Bismarck, Beveridge, and mixed/out-of-pocket models, to obtain a European perspective. FINDINGS: Countries, such as Great Britain and Scandinavia (Beveridge tax-based health systems), were inclined to implement and use person-centred care. The relative freedom of a market (Bismarck/mixed models) did not seem to nurture demand for PCC. In countries with an autocratic culture, that is, a high-power distance, such as Mediterranean countries, PCC was regarded as foreign and not applicable. Another reason for difficulties with PCC was the tendency for corruption to hinder equity and promote inertia in the healthcare system. RESEARCH LIMITATIONS/IMPLICATIONS: The sample of two to three participants divided into the micro, meso, and macro level for each included country was problematic to find due to contacts at national level, a bureaucratic way of working. Some information got caught in the system, and why data collection was inefficient and ran out of time. Therefore, a variation in participants at different levels (micro, meso, and macro) in different countries occurred. In addition, only 27 out of the 49 European countries were included, therefore, conclusions regarding healthcare system are limited. PRACTICAL IMPLICATIONS: Support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC. ORIGINALITY/VALUE: Fragmented health systems divided by separate policy documents or managerial roadmaps hindered local or regional policies and made it difficult to implement innovation as PCC. Therefore, support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.

Adoption of the concept of person-centred care into discourse in Europe: a systematic literature review.

PURPOSE: This study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge, Bismarck, out of pocket). DESIGN/METHODOLOGY/APPROACH: A literature review inspired by the SPICE model, using both scientific studies (CINHAL, Medline, Scopus) and grey literature (Google), was conducted. A total of 1,194 documents from CINHAL (n = 139), Medline (n = 245), Scopus (n = 493) and Google (n = 317) were analysed for content and scope of person-centred care in each country. Countries were grouped based on healthcare systems. FINDINGS: Results from descriptive statistics (percentage, range) revealed that person-centred care was most common in the United Kingdom (n = 481, 40.3%), Sweden (n = 231, 19.3%), the Netherlands (n = 80, 6.7%), Northern Ireland (n = 79, 6.6%) and Norway (n = 61, 5.1%) compared with Poland (0.6%), Hungary (0.5%), Greece (0.4%), Latvia (0.4%) and Serbia (0%). Based on healthcare systems, seven out of ten countries with the Beveridge model used person-centred care backed by scientific literature (n = 999), as opposed to the Bismarck model, which was mostly supported by grey literature (n = 190). PRACTICAL IMPLICATIONS: Adoption of the concept of person-centred care into discourse requires a systematic approach at the national (politicians), regional (guidelines) and local (specific healthcare settings) levels visualised by decision-making to establish a well-integrated phenomenon in Europe. SOCIAL IMPLICATIONS: Evidence-based knowledge as well as national regulations regarding person-centred care are important tools to motivate the adoption of person-centred care in clinical practice. This could be expressed by decision-making at the macro (law, mission) level, which guides the meso (policies) and micro (routines) levels to adopt the scope and content of person-centred care in clinical practice. However, healthcare systems (Beveridge, Bismarck and out-of-pocket) have different structures and missions owing to ethical approaches. The quality of healthcare supported by evidence-based knowledge enables the establishment of a well-integrated phenomenon in European healthcare. ORIGINALITY/VALUE: Our findings clarify those countries using the Beveridge healthcare model rank higher on accepting/adopting the concept of person-centered care in discourse. To adopt the concept of person-centred care in discourse requires a systematic approach at all levels in the organisation-from the national (politicians) and regional (guideline) to the local (specific healthcare settings) levels of healthcare.

A transition out of the darkness: Patients' experience of the recovery phase after treatment for head and neck cancer.

PURPOSE: To explore the recovery experience of patients who completed medical treatment for head and neck cancer (HNC). METHOD: The study conducted interviews with a strategic sample of 12 patients at an oncology clinic. Interview data were analyzed by qualitative content analysis with a deductive approach based on transition theory. RESULTS: The transition theory coding frame for patients' descriptions of their recovery process produced four categories: properties, personal conditions, process indicators, and outcome indicators. Personal conditions, such as cultural beliefs and attitudes, impact the outcome of recovery, and necessitate interaction throughout the care chain using the person-centered care approach to help survivors master their changed living conditions during recovery after HNC. The transition was described as a journey out of a dark period characterized by a struggle with the side effects of chemotherapy and radiation treatment. CONCLUSIONS: This study highlighted the use of person-centered care to facilitate transition in the recovery phase, supported by an intra-professional team that collaborates during the care chain (primary care to hospital care). Patient education and self-care are tools that improve the transition from illness to everyday life.

Challenges When Translating and Culturally Adapting a Measurement Instrument: The Suitability and Comprehensibility of Materials (SAM+CAM).

There is evidence that low suitability and comprehensibility of printed education materials (PEMs) affects patients' and relatives' ability to read and comprehend information. However, few instruments measure the suitability of written information, and none exist in the Swedish language. The aim was to describe the translation and adaptation of the Suitability and Comprehensibility of Materials (SAM+CAM) instrument into the Swedish language and health care context and to explore challenges related to this process. The SAM+CAM instrument was translated and culturally adapted in five steps: forward translation, synthesis, back translation, expert review, and pretests. Differences were found when translating and culturally adapting the SAM+CAM instrument in the areas of semantic, idiomatic, and experiences. Participants revealed several clarity inconsistencies between items. They also identified linguistic differences and unfamiliar wording; they found that the instrument was perplexing to use and lacked knowledge regarding the specific health care areas in the examined PEMs. The cultural perspective is a significant factor that influences the usability of PEMs. Therefore, expert groups of participants are useful when adapting instruments to different cultures. The Swedish SAM+CAM instrument requires experienced and highly qualified raters.

Nursing students' experiences with refugees with mental health problems in Jordan: A qualitative content analysis.

OBJECTIVES: The aim of this study was to describe Jordanian nursing students' experience of caring for refugees with mental health problems. BACKGROUND: According to refugees' experiences of crisis, a well-educated staff is needed to provide high quality of care due to mental health problems. Therefore, health professionals play an important role in creating an environment that promotes human rights regardless of ethnic origin. SETTINGS, PARTICIPANTS, METHOD: The study comprised eight interviews and was analysed using content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nursing students' perspective and thoughts regarding caring for refugees with mental health problems. RESULTS: The results formed one category: to be challenged by refugees' mental health issues and three subcategories: managing refugees' mental health needs, affected by refugees' mental health, and improve mental healthcare for refugees. CONCLUSION: Language problems could be managed by using interpreters to decrease cultural clashes to facilitate equal healthcare. In addition, well-educated (theoretical knowledge) and trained (practical knowledge) nursing students have potential to fulfil refugees' care needs regardless of ethnicity or background by using nursing interventions built on communication skills and cultural competences (theory, practice) to facilitate high quality of healthcare.

Reduced time from diagnosis to stone-free status in patients with ureteral calculi.

Purpose - The purpose of this paper is to describe an improvement project and its effects on decreasing the time from diagnosis to treatment for patients with kidney stones and to reduce the negative effects related to untreated stones at one hospital in western Sweden. Design/methodology/approach - A quantitative descriptive study based on Nolan's improvement model was used. The quality improvement effects were evaluated using statistical process control. Findings - Extracorporeal shock wave lithotripsy treatment's positive effects within 48 hours were described as efficiency (decreased waiting time) from diagnosis to treatment, even if a re-treatment was necessary. The results also showed a reduction in the usage of percutaneous nephropyelostomies as a treatment option. Research limitations/implications - This study includes data from one department at one hospital in one country. Comparative data include the time from acute radiological examination to final treatment but not total re-treatments, complications or time to up following radiological examination. However, the study was performed over one year and analyzed data from medical records in a systematic way. Practical implications - This study may inspire measuring and developing routines from diagnosis to treatment for patients who are transferred within different departments at one hospital. Social implications - By measuring the working process, resource use within a healthcare organization could be visualized. Planning and co-operation at different managerial levels are key factors for success when improvement projects are performed. Originality/value - Studies in improvement projects considering ureteral or kidney stones are generally lacking; thus, this study is important for improving the care of patients with this diagnose.

To be involved - A qualitative study of nurses' experiences of caring for dying patients.

OBJECTIVE: The aim of this study was to describe nurses' experiences (>two years) of caring for dying patients in surgical wards. BACKGROUND: Palliative care is included in education for nurses. However, the training content varies, and nurse educators need to be committed to the curriculum regarding end-of-life situations. A lack of preparation among newly graduated nurses regarding dying and death could lead to anxiety, stress and burnout. Therefore, it is important to improve knowledge regarding end-of-life situations. SETTING, PARTICIPANTS AND METHOD: A qualitative descriptive study was carried out in two surgical wards in the southern part of Sweden. The study comprised six interviews with registered nurses and was analysed using manifest qualitative content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nurses' perspectives and thoughts regarding dying patients. RESULTS: The results formed one category (caring-to be involved) and three subcategories (being supportive, being frustrated and being sensitive in the caring processes). Nurses were personally affected and felt unprepared to face dying patients due to a lack of knowledge about the field of palliative care. Their experiences could be described as processes of transition from theory to practice by trial and error. CONCLUSION: Supervision is a valuable tool for bridging the gap between theory and practice in nursing during the transition from novice to expert. Improved knowledge about palliative care during nursing education and committed nursing leadership at the ward level facilitate preparation for end-of-life situations.

An improvement project within urological care.

PURPOSE: The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones. DESIGN/METHODOLOGY/APPROACH: A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months. FINDINGS: The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes. RESEARCH LIMITATIONS/IMPLICATIONS: This study includes one team (six members, different health professionals) within the same urology department. PRACTICAL IMPLICATIONS: Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work. SOCIAL IMPLICATIONS: Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work. ORIGINALITY/VALUE: Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

The visualisation of clinical leadership in the content of nursing education--a qualitative study of nursing students' experiences.

OBJECTIVE: The aim of this study was to describe nursing students' experiences of clinical leadership during their last year of education. BACKGROUND: Work as a nurse is complex with several demands from stakeholders who are colleagues, managers, patients and relatives. Therefore, it is important to provide students with tools for a forthcoming professional life as a nurse. SETTING, PARTICIPANTS AND METHOD: A qualitative descriptive study was carried out in Jordan. Narratives (n=20) written by nursing students in their last year before graduation as a registered nurse were collected. The data were analysed by a manifest content analysis. RESULTS: The results formed one category: (Clinical leadership-safety in being a nurse), and three subcategories (eye-opener, a role model and bridging the gap) described the students' clinical leadership experiences due to the preparation process for being a nurse. Clinical leadership applies theory to practice by using a holistic view in nursing. CONCLUSION: Clinical leadership is a valuable tool for bridging the gap between theory and practice in nursing education. Skills within nursing management clarify and simplify nursing activities, which facilitates the transition from student to nurse. Focus on learning needs in nursing management is needed for stakeholders within education and health care organisations to facilitate graduation of well skilled nurses.

Political experiences of changing the focus in elderly care in one municipality.

AIM: To describe local politicians' experiences of an ongoing planning process for elderly care for the future in a medium-sized municipality in western Sweden. BACKGROUND: Elderly care is facing challenges because of an ageing population. METHOD: The study comprised a total of eight semi-structured interviews with politicians. The interviews were analysed using manifest qualitative content analysis. RESULTS: One category (political consensus) and three subcategories (involvement generates security, trust in change management and confidence to create visions) were identified. CONCLUSIONS: Political consensus across elderly care organisations could establish a sense of security for old people, their relatives and the staff in particular. Continuous information and support from different managerial levels is one way of implementing changes within large organisations. However, further research is needed to describe how to develop future elderly care. IMPLICATIONS FOR NURSING MANAGEMENT: An ageing population requires cooperation across provider boundaries to further develop high-quality elderly care services. Nursing leadership during a change process is crucial to implement political decisions in care organisations. Furthermore, active marketing of the health care profession for elderly care is needed as well as new knowledge regarding old people.

District nurses' experiences with the free-choice system in Swedish primary care.

This article aims to describe the experiences of district nurses regarding their work situation after the free-choice system in primary care in Sweden was implemented. The study comprised a total of 17 semi-structured narratives with district nurses. The narratives were analysed using manifest qualitative content analysis. One category,'being an underused resource', and three subcategories, 'being financially aware','being flexible' and 'being appealing', were identified. A focus on economic benefit can limit the cooperation and exchange of experiences within and between different care units, which could have a negative impact on the quality of care due to competition between different care providers. Underused resources and restrictions in terms of improvement skills have an impact on job satisfaction and the working environment, and affect the quality of care as a result.

Elderly Men's Experience of Information Material about Melanoma-A Qualitative Study.

Malignant melanoma is an aggressive disease that has been increasing worldwide. Public education is trying to focus on reducing intense sun exposure and raise awareness of signs and symptoms to prevent illness. The aim of the study was to describe and analyze elderly men's (over 65 years) experience of an information booklet regarding malignant melanoma. The study comprised of a total of 15 interviews with elderly men. The interviews were analyzed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. One category, Security-to act, and three subcategories, Availability-to use, Clarity-to understand, and Awareness-to know, were identified to describe the men's experiences of information material about melanoma. By using person-centered care, based on a holistic approach focusing on men's need for security to act on specific risk factors and to do skin self-examination, health could be improved. The results of this study could help other health organizations to develop information material to prevent illness, such as for skin self-examination. Strategies concerning educating, preparing, and training health professionals in interpersonal communication skills should be implemented in healthcare organizations to meet patients' information needs about illness to develop continuous learning and quality improvement.

First-line managers' experiences of alternative modes of funding in elderly care in Sweden.

AIM: The aim of this study was to describe first-line managers' experiences of alternative modes of funding elderly care in two communities in western Sweden. BACKGROUND: A growing elderly population demands alternative modes of funding elderly care for better outcomes for patients and better efficiency as it is publicly funded through taxation. METHODS: The study comprised a total of eight semi-structured interviews with first-line managers working within elderly care. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. RESULTS: One category, quality improvement, and four subcategories freedom of choice, organisational structure, quality awareness and market forces effects were identified to describe first-line managers' experiences of the operation of elderly care. CONCLUSIONS: Quality improvement was an important factor to deal with when elderly care was operated in different organisational perspectives, either private or public. The first-line manager is a key person for developing a learning organisation that encourages both staff, clients and their relatives to improve the organisation. Moreover, person-centred care strengthens the client's role in the organisation, which is in line with the government's goal for the quality improvement of elderly care. However, further research is needed on how quality improvement could be developed when different caregivers operate in the same market in order to improve care from the elderly perspective. IMPLICATIONS FOR NURSING MANAGEMENT: This study highlights alternative modes of funding elderly care. The economical perspectives should not dominate without taking care of quality improvement when the operation of elderly care is planned and implemented. Strategies such as a learning organisational structure built on person-centred care could create quality improvement in elderly care.

Quality registry, a tool for patient advantages - from a preventive caring perspective.

AIM: The aim of this study was to describe nurses' experiences of a recently implemented quality register, Senior Alert, at two hospitals in Sweden. BACKGROUND: In Sweden, in recent decades, a system of national quality registries has been established in health and medical services for better outcomes for patients, professional development and a better functioning system. Senior Alert (SA) is one quality registry, aimed at preventing malnutrition, pressure ulcers and falls in elderly care. METHODS: The study comprised a total of eight interviews with nurses working with SA at the ward level. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. All persons who were asked to participate in the study consented to do so. RESULTS: One category 'Patient Advantages' and three subcategories 'Conscious Persevering', 'Supporting Structure' and 'Committed Leadership' were identified to describe staff experiences of implementing SA. CONCLUSIONS: Implementation processes need to be sustainable at both staff and managerial levels. A key factor in implementing and using a quality registry in prevention care could be described as keeping the flame burning. However, further research is needed on how patient advantages could be developed using other quality registries in order to improve care from a patient perspective. IMPLICATIONS FOR NURSING MANAGEMENT: The results of this study could help other organizations implement quality registries or other change processes, for example new guidelines and treatment. Strategies concerning organizational structure and committed leadership could increase the usefulness of knowledge systems on all levels, which could enable continuous learning and quality improvement in health care.

Supporting "two-getherness": assumption for nurse managers working in a shared leadership model.

New leadership models are developing; one of them is shared leadership, which is often described at the team level. In this study, shared leadership is explored at the managerial level. The aim of this case study was to describe two nurse manager's experiences of working together as equal partners within a shared leadership model at an intensive care unit in Sweden. The study comprised a total of 12 interviews collected over three years with two nurse managers who worked together in shared leadership. 'Developing active influence to improve care' was identified as the core category, which was related to five subcategories 'Safeguarding leadership', 'Enabling leadership', 'Supporting 'two'-getherness', 'Transparent determination' and 'Balancing power'. A new construct 'two'-getherness' was created, this means that two equal nurse managers within a trustful relationship share responsibility and tasks by using the couples' strengths and minimizing their weaknesses. Nurse managers experienced increased opportunities to improve work standards and do the very best for the ward. Moreover, the shared leadership model balanced the burden of day-to-day management. A model of shared leadership was created for further research.

Nurses' views of shared leadership in ICU: a case study.

New management models develop; one of them is shared leadership where two nurse managers share tasks and responsibility for a unit. The overall aim of this study was to describe the view of the staff about shared leadership at an ICU in Sweden and to study if there were any differences in perceptions between staff groups. This unit had changed the management organisation from single leadership (one nurse manager) to shared leadership (two nurse managers). Sixty-four (79%) registered nurses and assistant nurses responded to a 72 item questionnaire measuring social and organisational factors at work, especially leadership and shared leadership. The results showed that staff reported positive views in relation to the dimensions 'Organisational culture', 'Social interactions', 'Work satisfaction', 'Leadership', 'Shared leadership' and 'Work motives'. Registered nurses reported more positive views than assistant nurses in relation to the dimensions: 'Organisational culture', 'Social interactions', 'Work satisfaction' and 'Leadership'. Further, females had more positive views than males on the dimension 'Social interactions'. Staff described that shared leadership positively influenced the work in terms of confidence. In conclusion, staff reported positive views of work and the model shared leadership in the investigated ICU. One implication is that nurse managers have to be conscious of different health professionals in the unit and it is important to offer a good working environment for all staff. However, more research is needed within the area of shared leadership. A future research project could be to add a qualitative research question about how work and shared leadership affects different health professionals in the day to day practice both at the managerial as well as the team level to improve health care.

Presence and availability: staff conceptions of nursing leadership on an intensive care unit.

A demand for high quality care has drawn attention to leadership issues. The nurse managing role has changed over the years and become more complex with a high burden of work. Few studies describe the perspective of 'those being lead'. The aim of this study was to describe staff conceptions about nursing leadership on an intensive care unit. Ten members of staff were interviewed and analysed according to a phenomenographical approach, focusing variations in how informants experience nursing leadership and make sense of the world around them. The findings show that nursing leadership was considered to be 'being present and available in daily work', 'supporting everyday practice', 'facilitating professional acknowledgement' and to 'improve care both as individuals and as a team'. Transformational leadership seemed to be suitable to meet the staff perspective. In such leadership communicative skills is a core to work with strong professionals by being present and available.

Balancing involvement: employees' experiences of merging hospitals in Sweden.

BACKGROUND: The health care of today stands in front of demands on financial and structural changes. New technology and global economy are forces driving on the change process. AIMS: The aim of this study is to describe and broaden the understanding of the employees' experience of being involved in a merger between two health care districts in Sweden. METHODS: This study was carried out from a qualitative approach according to the grounded theory tradition. From a theme guide with specific questions, 31 interviews were carried out with employees working in the health care. FINDINGS: Five categories emerged from the body of interviews: balancing involvement, trust respect, challenge and commitment. Balancing involvement was defined as an overall core category related to the other categories. The categories trust, respect, challenge and commitment were related to subcategories and affected the core category balancing involvement. CONCLUSIONS: The overall findings point to the importance of balancing the employees' involvement in order to reach goal fulfilment change in a merger process.