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Sjuksköterskans ledarskap i det patientnära vårdandet av äldre personer i kommunens hemsjukvård: Att leda i ett mellanrum av närhet och distans
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.ORCID iD: 0000-0003-2979-3705
2022 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim is to develop knowledge about the phenomenon of leading care close to the patient in community home care from the perspectives of older persons (aged 65 years and older), next of kin and registered nurses. Methods: A qualitative, descriptive and interpretative approach guided the methodology of this dissertation. The first study was a systematic literature review with the following research question: What implies registered nurses’ leadership close to older persons in community home care? The review was documented in accordance with the PRISMA reporting guidelines. Nine articles, all with a qualitative research approach, met the quality criteria, and a qualitative research synthesis of the data was performed in four stages. Studies II–III were interview studies consisting of individual interviews with 12 older persons in their own homes (Study II) and telephone interviews with 11 next of kin (Study III), focusing on their experiences of registered nurses’ leadership of the care close to older persons in community home care. The data material in Studies II–III was analysed using qualitative content analysis. Study IV was based on the reflective lifeworld research method, comprising individual interviews with nine registered nurses working in community home care. The data material was analysed with a lifeworld hermeneutic approach. Main Findings: Leading care close to the patient in community home care was found to consist of an ethical demand that came with the responsibility for leading those involved in the care – in a space between closeness and distance. From a caring science perspective, leading care in a space between closeness and distance can be understood as leading between health and illness, between biology and existence and being aware of the older person’s autonomy and integrity, allowing the other to trustingly surrender to care. Leading care can then mean maintaining an ethical approach in the meeting with the patient to safeguard dignified care for older persons in need of home care. Conclusions: The knowledge gained from these studies can help us better understand the prerequisites for leading the care of patients in community home care and contribute to improving the care for patients who are in an existentially vulnerable life situation. 

Place, publisher, year, edition, pages
orås: Högskolan i Borås, 2022.
Series
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 132
Keywords [en]
Caring science, leading care, registered nurses, community home care, patient perspective, older persons, next of kin, qualitative research
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-28661ISBN: 978-91-89271-80-7 (print)ISBN: 978-91-89271-81-4 (electronic)OAI: oai:DiVA.org:hb-28661DiVA, id: diva2:1698984
Public defence
2023-02-03, C203, Allégatan 1, Borås, 09:30 (Swedish)
Opponent
Supervisors
Note

Disputationen sänds via videolänk, för information se kalendariet påhb.se/forskning.

Available from: 2023-01-13 Created: 2022-09-26 Last updated: 2022-12-30Bibliographically approved
List of papers
1. What implies registered nurses’ leadershipclose to older adults in municipal homehealth care? A systematic review
Open this publication in new window or tab >>What implies registered nurses’ leadershipclose to older adults in municipal homehealth care? A systematic review
2020 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 19, no 30, p. 1-11, article id 1472-6955Article in journal (Refereed) Published
Abstract [en]

Background: Registered nurses are key figures in municipal home health care for older adults. Thus, registerednurses’ leadership is crucial to a successful and preventive care process as well as a supportive organization in orderto achieve safe care. However, there is limited research on what registered nurses’ leadership implies close to olderadults in municipal home health care. Thus, the aim is to compile and critically evaluate how international researchresults describe registered nurses’ leadership close to older adults in municipal home health care.

Methods: A systematic literature review was performed in accordance with a qualitative research study. The mainsearch was conducted on 20 April 2018. The review was reported according to the PRISMA guidelines and is registeredin the PROSPERO database (ID# CRD42019109206). Nine articles from PubMed and CINAHL meet the quality criteria. Asynthesis of data was performed in four stages according to qualitative research synthesis.

Results: Ten themes describe what registered nurses’ leadership close to older adults in municipal home health careentails: trust and control; continuous learning; competence through knowledge and ability; nursing responsibility on anorganizational level; application of skills; awareness of the individual’s needs and wholeness; mutual support; mutualrelationships; collaborating on organizational and interpersonal levels; and exposure to challenges.

Conclusions: Registered nurses leading close to older adults in municipal home health care implies being multi-artists.Nursing education, including specialist education for registered nurses, should prepare individuals for their unique andcomplex leadership role as a multi-artist. Municipal employers require knowledge about what registered nurses’leadership implies in order to create adequate conditions for their leadership objectives to achieve safe care. Furtherresearch is warranted to explore registered nurses’ leadership close to older adults in municipal home health care fromdifferent perspectives, such as older adults and next of kin.

Place, publisher, year, edition, pages
Springer Nature, 2020
Keywords
Home health care, Leadership, Multi-artist, Municipal, Older adults, Registered nurse, Systematic review
National Category
Medical and Health Sciences
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-23162 (URN)10.1186/s12912-020-00413-1 (DOI)000528899900001 ()2-s2.0-85084292503 (Scopus ID)
Projects
Sjuksköterskans patientnära ledarskap i vården för den äldre människan i kommunens hemsjukvård
Available from: 2020-04-29 Created: 2020-04-29 Last updated: 2022-12-30Bibliographically approved
2. ‘My registered nurse’: Older people’s experiences of registered nurses’ leadership close to them in community home care in Sweden
Open this publication in new window or tab >>‘My registered nurse’: Older people’s experiences of registered nurses’ leadership close to them in community home care in Sweden
2021 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, article id e12399Article in journal (Refereed) Published
Abstract [en]

Aim

To explore older people's experiences of registered nurses? leadership close to them in community home care.

Introduction

In Sweden and throughout the world, the number of people 65 years and older is increasing. While older people are living for more years, living longer can bring more diseases and disabilities, which might lead to the need for home care. Registered nurses are responsible for older people's care needs in their leadership in community home care; this is a part of their professional role as registered nurses, and it implies that they must be multi-artists.

Design

An explorative and inductive design was used in two communities in western Sweden.

Methods

Individual interviews were conducted with older people (n = 12) with at least one year of experience with community home care. Data were analysed using qualitative content analysis. Results The results are presented in the theme "my registered nurse", including five categories - relationship, professional competence, nursing interventions, coordination and collaboration and organisation - and 15 sub-categories.

Conclusions

These findings are based on older people's own experiences. This is specific, as the phenomenon of the RNs leadership is rarely explored from the perspective of older people.

Implications for practice

There is a need for organisations to create more opportunities for older people to have their own registered nurses leading close to them. This is because registered nurses have specific competences for meeting older people's individual needs and involving them as competent partners in satisfying their care needs.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
community home care, interview, leadership, older people, registered nurse
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-26160 (URN)10.1111/opn.12399 (DOI)000669227800001 ()2-s2.0-85109034978 (Scopus ID)
Available from: 2021-08-11 Created: 2021-08-11 Last updated: 2022-12-30
3. Next of kin’s experiences of registered nurses’ leadership close to older adults in municipal home care in Sweden: an interview study
Open this publication in new window or tab >>Next of kin’s experiences of registered nurses’ leadership close to older adults in municipal home care in Sweden: an interview study
2021 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 20, no 1, article id 213Article in journal (Refereed) Published
Abstract [en]

Background: Next of kin to older adults over 65 years in municipal home care are concerned whether their older adults’ needs are being met. In municipal home care, the registered nurses’ leadership is important and complex, entailing multi-artist skills involving the older adults and their next of kin. Yet, little is known about next of kin’s experiences of registered nurses’ leadership. Thus, the aim of this study was to explore next of kin’s experiences of registered nurses’ leadership close to older adults in municipal home care. Methods: Individual telephone interviews were conducted with next of kin (n = 11) of older adults from April to September 2020 in two municipalities in western Sweden. Data were analysed using qualitative content analysis. Results: The results are presented with the theme, registered nurses do what they can, including two categories, interaction and competence, and the subcategories, relationship, communication, availability, responsibility, team leadership and cooperation. Registered nurses’ leadership was experienced as a balancing act between their commitments and what they were able to achieve. Conclusions: Next of kin’s experiences of registered nurses’ leadership can contribute knowledge that will strengthen and prepare registered nurses for their leadership roles. This knowledge can support the development of policies for organisational preconditions that ensure quality and safe care to older adults in municipal home care. © 2021, The Author(s).

Place, publisher, year, edition, pages
BioMed Central Ltd, 2021
Keywords
Interviews, Leadership, Municipal home care, Next of kin, Older adult, Registered nurse, aged, article, clinical article, content analysis, female, home care, human, male, responsibility, Sweden, telephone interview
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-26976 (URN)10.1186/s12912-021-00745-6 (DOI)000712833300001 ()2-s2.0-85118278511 (Scopus ID)
Note

Export Date: 2 December 2021; Article; Correspondence Address: Claesson, M.; Faculty of Caring Science, Sweden; email: maria.claesson@hb.se

Available from: 2021-12-02 Created: 2021-12-02 Last updated: 2022-12-30Bibliographically approved

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