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  • 1.
    Andreasson, Jörgen
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eriksson, Andrea
    Dellve, Lotta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Health care managers' views on and approaches to implementing models for improving care processes.2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834Article in journal (Refereed)
    Abstract [en]

    AIM: To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes.

    BACKGROUND: In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome.

    METHOD: In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory.

    RESULTS: 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work.

    CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.

  • 2.
    Arman, Rebecka
    et al.
    School of Business, Economics and Law, University of Gothenburg.
    Dellve, Lotta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wikström, Ewa
    Törnström, Linda
    What health care managers do: applying Mintzberg's structured observation method2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, no 6, p. 718-729Article in journal (Refereed)
    Abstract [en]

    Aim The aim of the present study was to explore and describe what characterizes first- and second-line health care managers' use of time. Background Many Swedish health care managers experience difficulties managing their time. Methods Structured and unstructured observations were used. Ten first- and second-line managers in different health care settings were studied in detail from 3.5 and 4 days each. Duration and frequency of different types of work activities were analysed. Results The individual variation was considerable. The managers' days consisted to a large degree of short activities (<9 minutes). On average, nearly half of the managers' time was spent in meetings. Most of the managers' time was spent with subordinates and <1% was spent alone with their superiors. Sixteen per cent of their time was spent on administration and only a small fraction on explicit strategic work. Conclusions The individual variations in time use patterns suggest the possibility of interventions to support changes in time use patterns. Implications for nursing management A reliable description of what managers do paves the way for analyses of what they should do to be effective.

  • 3.
    Bergh, Anne-Louise
    University of Borås, School of Health Science.
    Registered nurses’ perceptions of conditions for patient education: focusing on organizational, environmental and professional cooperation aspects.2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 6, p. 758-770Article in journal (Refereed)
    Abstract [en]

    AIM: To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. BACKGROUND: Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. METHOD: A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. RESULTS: Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. CONCLUSIONS: Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. IMPLICATIONS FOR NURSING MANAGEMENT: Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work.

  • 4. Berglund, Mia
    et al.
    Sjögren, Reet
    Ekebergh, Margaretha
    University of Borås, School of Health Science.
    Reflect and learn together: when two supervisors interact in the learning support process of nurse education2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 2, p. 152-158Article in journal (Refereed)
    Abstract [en]

    Aim  To describe the importance of supervisors working together in supporting the learning process of nurse students through reflective caring science supervision. Background  A supervision model has been developed in order to meet the need for interweaving theory and practice. The model is characterized by learning reflection in caring science. A unique aspect of the present project was that the student groups were led by a teacher and a nurse. Method  Data were collected through interviews with the supervisors. The analysis was performed with a phenomenological approach. Results  The results showed that theory and practice can be made more tangible and interwoven by using two supervisors in a dual supervision. The essential structure is built on the constituents ‘Reflection as Learning Support’, ‘Interweaving Caring Science with the Patient’s Narrative’, ‘The Student as a Learning Subject’ and ‘The Learning Environment of Supervision’. Conclusion  The study concludes that supervision in pairs provides unique possibilities for interweaving and developing theory and practice. Implications for nursing management  The supervision model offers unique opportunities for cooperation, for the development of theory and practice and for the development of the professional roll of nurses and teachers.

  • 5. Blomberg, Karin
    et al.
    Isaksson, Ann-Khristin
    Allvin, Renée
    Bisholt, Birgitta
    Ewertsson, Mona
    Kullén Engström, Agneta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ohlsson, Ulla
    Sundler Johansson, Annelie
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gustafsson, Margareta
    Work stress among newly graduated nurses in relation to workplace and clinical group supervision2016In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 1, p. 80-87Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate occupational stress among newly graduated nurses in relation to the workplace and clinicla group supervision. Being a newly graduated nurse is particulary stressful. Whar remains unclear is wehter teh workplace and clinical group supervision affect the stress. A cross-sectional comperative study was performed. Data were collected by means of a numerical scale measuring occupational stress, questions about workplace and clinicla group supervision. One hundred and thirteen nusres were included in the study. Conclusions: Newly graduated nurses experience great strss and need support. Nusrse participating in clinical group supervision reported significantly less stress.

  • 6.
    Bondas, Terese
    University of Borås, School of Health Science.
    Paths to Nursing Leadership2006In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 13, no 5, p. 1-8Article in journal (Refereed)
  • 7. Cronquist, A
    et al.
    Lützén, K
    Nyström, Maria
    University of Borås, School of Health Science.
    Nurses’ lived experiences of moral stress support in the intensive care context2006In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 14, no 5, p. 405-413Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyse and describe lived experiences of support in situations characterized by critical care situations and moral stress in intensive care nursing. An exploratory interpretative study was conducted. Data consisted of interviews with 36 nurses from different types of intensive care units. The first level of analysis of data identified contextual factors, such as type and purpose of support and working conditions. On the next level of analysis five tentative interpretations were identified: (1) receiving organized support is a matter of self-determination, (2) whether to participate in organized support or to be off duty are experienced as mutually exclusive, (3) dealing with moral stress is experienced as a private matter, (4) colleagues managing moral stress serve as models in stress support and (5) not being able to deal with moral stress urges one to seek outside support. A comparison of these interpretations identified three major themes: availability, accessibility and receptivity of support. The main interpretation and conclusion were: lived experience of moral stress support involves an interconnectedness between structural and existential factors. Thus, adequate moral stress support presupposes an allowable professional climate and access to caring supervision.

  • 8. Cronqvist, A
    et al.
    Nyström, Maria
    University of Borås, School of Health Science.
    A theoretical argumentation on the consequences of moral stress2007In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 15, no 4, p. 458-465Article in journal (Refereed)
    Abstract [en]

    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden. agneta.cronqvist@esh.se BACKGROUND: Intensive care units are characterized by heavy workloads, increasing work complexity and ethical concerns related to life-and-death decisions. In the present study, it is assumed that there is a relationship between moral stress, support and competence for nurses in intensive care units. AIM: To analyse and describe the theoretical relationship between moral stress and support on the one hand and competence on the other, in the context of intensive care. METHOD: A form of qualitative secondary analysis based on the findings from three original studies. In the analytic process a theory on professional competence was used. FINDINGS: The findings suggest that imbalance due to moral stress between different competences hinders the development of collectively shared caring competence. CONCLUSIONS: Moral stress cannot be totally eliminated in the intensive care unit. But moral stress is not only a problem. It can also become a driving force to stimulate competence.

  • 9.
    Dellve, Lotta
    et al.
    Göteborg University.
    Morberg, S
    Karolinska Institute.
    Lagerström, M
    Karolinska Institute.
    The perceived perceptions of head school nurses in developing school nursing roles in schools2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, ISSN 0966-0429, Vol. 17, no 7, p. 813-821Article in journal (Refereed)
    Abstract [en]

    Aim  To gain a deeper understanding of how Swedish head school nurses perceive their leadership in developing school health care. Background  A well-functioning school health care is important for promoting the health of children and young people. Method  Constructivist-grounded theory was used to analyse 11 individual interviews with nine head school nurses. Results  Head school nurses strive to find a balance between what they experience as vague formal goals and strong informal goals which leads to creating local goals in order to develop school health care. Conclusion  The head school nurse’s job is experienced as a divided and pioneering job in which there is uncertainty about the leadership role. They provide individual support to school nurses, are the link between school nurses and decision makers and highlight the importance of school nurses’ work to organizational leaders. Implications for nursing management  This study shows that school health care needs to be founded on evidence-based methods. Therefore, a structured plan for education and training in school health care management, based on research and in cooperation with the academic world, would develop the head school nurses’ profession, strengthen the position of school health care and advance the school nurses’ work.

  • 10.
    Dellve, Lotta
    et al.
    Göteborg University.
    Wikström, E
    Göteborg University.
    Managing complex workplace stress in health care organizations: leaders' perceived legitimacy conflicts2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, ISSN 0966-0429, Vol. 17, no 8, p. 931-941Article in journal (Refereed)
    Abstract [en]

    AIM: To conceptualize how health care leaders' strategies to increase their influence in their psychosocial work environment are experienced and handled, and may be supported. BACKGROUND: The complex nature of the psychosocial work environment with increased stress creates significant challenges for leaders in today's health care organizations. METHOD: Interviews with health care leaders (n = 39) were analysed in accordance with constructivist grounded theory. RESULTS: Compound identities, loyalty commitments and professional interests shape conditions for leaders' influence. Strategies to achieve legitimacy were either to retain clinical skills and a strong occupational identity or to take a full leadership role. Ethical stress was experienced when organizational procedural or consequential legitimacy norms were in conflict with the leaders' own values. Leadership support through socializing processes and strategic support structures may be complementary or counteractive. CONCLUSIONS: Support programmes need to have a clear message related to decision-making processes and should facilitate communication between top management, human resource departments and subordinate leaders. Ethical stress from conflicting legitimacy principles may be moderated by clear policies for decision-making processes, strengthened sound networks and improved communication. IMPLICATIONS FOR NURSING MANAGEMENT: Supportive programmes should include: (1) sequential and strategic systems for introducing new leaders and mentoring; (2) reflective dialogue and feedback; (3) team development; and (4) decision-making policies and processes.

  • 11. Friberg, Febe
    et al.
    Granum, Vigdis
    Bergh, Anne-Louise
    University of Borås, School of Health Science.
    Nurses’ patient-education work: conditional factors - an integrative review.2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 2, p. 170-186Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this review was to identify conditional factors for nurses' patient-education work and to identify foundational aspects of significance when designing studies on this patient-education work. BACKGROUND: A few reviews of nurses patient education work exist, published up to 30 years ago, spawning interest in performing a review of more recent studies. EVALUATION: A search of CINAHL, MEDLINE and ERIC was made for articles dating from 1998 to 2011. Thirty-two articles were selected and an integrative review was performed. KEY ISSUES: Conditional factors were identified and beliefs and knowledge, environment, organization, interdisciplinary cooperation, collegial teamwork and patient education activities. A model was developed to describe foundational aspects of significance when designing studies. CONCLUSIONS: The conditional factors are to be seen as either enabling or hindering the accomplishment of evidence-based patient education and the level of person centredness, patient safe care and ethics - something that has to be considered when designing studies. IMPLICATIONS FOR NURSING MANAGEMENT: More detailed studies are required to clarify the nature of patient education work and to create realistic conditions that enable the role to be fulfilled in everyday work. Such knowledge is of significance for nursing management in developing supportive activities for nurses.

  • 12.
    Josefsson, Karin
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    To lead and to be led in municipal care for older people in Sweden as perceived by registered nurses2011In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 19, no 4, p. 498-506Article in journal (Refereed)
    Abstract [en]

    AIM

    To describe registered nurses' (RNs) perceptions of their own leadership and of their immediate line management, as well as leadership's organizational prerequisites in municipal elderly care.

    BACKGROUND

    Nursing leadership is a main factor influencing care quality. In spite of this, there is a leadership crisis in municipal elderly care.

    METHOD

    A descriptive design utilizing a questionnaire. The setting was 60 residential care homes in Sweden with 213 participating nurses. The response rate was 62%.

    RESULTS

    Most nurses (59%) viewed themselves as leaders of a smaller group, whereas 28% did not consider themselves as leaders at all. Few nurses had the will to develop their leadership competence. In all, 25% of the nurses had unresolved serious conflicts with their immediate line management. Half perceived receiving no or little feedback from their immediate line management. A majority had no organized supervision. They perceived, on average, organizational prerequisites as unclear, with few possibilities for leadership competence development.

    CONCLUSIONS

    Nurses need to be more willing to develop their leadership skills. Nurses need managers to support them in their leadership roles. They need distinct and supportive organizational prerequisites for leadership.

    IMPLICATIONS FOR NURSING MANAGEMENT

    It is crucial to provide distinct and supportive organizational prerequisites for nursing leadership.

  • 13.
    Jörgen, Andreasson
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eriksson, Andrea
    Dellve, Lotta
    Healthcare managers’ views on and approaches to implementing models for improving care processes2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 2, p. 219-227Article in journal (Refereed)
    Abstract [en]

    Aim

    To develop a deeper understanding of health‐care managers' views on and approaches to the implementation of models for improving care processes.

    Background

    In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome.

    Method

    In‐depth interviews with first‐ and second‐line managers in Swedish hospitals were conducted and analysed using grounded theory.

    Results

    ‘Coaching for participation’ emerged as a central theme for managers in handling top–down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work.

    Conclusion and implications for nursing management

    Implementation models for improving care processes require a coaching leadership built on close manager–employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process‐oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.

  • 14.
    Kullén Engström, Agneta
    et al.
    [external].
    Axelsson, L
    Edgren, L
    Management vs symbolic leadership and hospitals in transition: a Swedish example2000In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 8, no 3, p. 167-173Article in journal (Refereed)
    Abstract [en]

    Aim To describe, analyse and interpret symbolic leadership in Swedish public hospitals. Background Swedish hospitals are undergoing major structural changes. Hospitals are amalgamated in order to increase productivity and accessibility and reduce health care costs. Method In-depth interviews have been performed with 54 politicians, senior civil servants, medical directors and trade union representatives at nine hospitals. The interviews have been analysed and interpreted following a grounded theory approach. Findings The results show that leadership is manifested in two dimensions—management and symbolic leadership. The management dimension comprises general leadership aspects like planning, regulation and control. In the symbolic leadership dimension, the leader acts as a guide, inspirer and visionary. Leaders consider they are acting in two large arenas: a public arena and a hospital arena. In the public arena their professional competence is thought to be most important and in the hospital arena their social competence. Conclusions Structural changes in Swedish hospitals have forced the actors to come out into the public arena, where they increasingly meet the media and have to defend budget cut-backs. This reduces their manoeuvring space in the hospital arena. When leaders work as a team, and make full use of their symbolic role, this helps to promote the process of transition. Symbolic leadership has a potential to increase the role repertory for not least the head nurse.

  • 15.
    Kullén Engström, Agneta
    et al.
    [external].
    Rosengren, K
    Axelsson, L
    The staff's experience of structural changes in the health and medical service in western Sweden1999In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 7, no 5, p. 289-298Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The structure and contents of the health and medical service have changed in recent years. The merger of Norra Alvsborgs and Uddevalla hospitals into one local district under one leadership (the NU medical service) is a Swedish example of a structural change. AIMS: This study intends to describe and analyse the staff's experience of a recently accomplished structural change in the local district NU medical service in the western part of Sweden. METHODS: This study has been carried out from a qualitative point of view inspired by grounded theory. From a theme guide with specific questions, 31 interviews were carried out with staff working in the NU medical service. FINDINGS: Four categories emerged from the body of interviews: 'participation', 'doubts', 'anxiety' and 'faith'. 'Participation' was defined as an overall core category, and was related to the other categories. The categories 'doubts', 'anxiety' and 'faith' were related to sub-categories and affected by the overall category 'participation'. CONCLUSIONS: The overall results point to the importance of participation of staff members concerned. The role of the leadership when undergoing structural changes is considered as a major factor to make other staff members participate.

  • 16.
    Larsson, Sara
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.
    Jutengren, Göran
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Dellve, Lotta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Sociology and Work Science, Gothenburg University, Sweden.
    The impact of restricted decision making autonomy on health care managers’ health and work performance2019In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 4, p. 706-714Article in journal (Refereed)
    Abstract [en]

    AIM:

    The aim of this study was to investigate how restricted decision making autonomy and conflicting demands impact operational managers' work performance and health.

    BACKGROUND:

    Managers at operational level (first and second-line managers') in health care organizations are commonly exposed to strain in their work situation with high demands and a challenging work context. Although they play an important role, the knowledge about the causal associations between stressful job demands and their consequences is limited.

    METHODS:

    A prospective design with questionnaire data collected at two points in time, one year apart, from a sample of operational managers (N = 162) at five Swedish hospitals was used to conduct a structural equation model (SEM) analysis with cross-lagged paths.

    RESULTS:

    Restricted decision making autonomy was negatively associated with both the managers' health and their managerial work performance over time.

    CONCLUSIONS:

    Health care managers' work performance and health may be sustained by the top management allowing them a higher degree of autonomy in their decision making.

    IMPLICATIONS FOR NURSING MANAGEMENT:

    This study suggests that nursing leaders should create the circumstances for operational managers' to have higher levels of autonomy in their area of responsibility and the freedom to prioritize their managerial workload. 

  • 17. Skagert, Katrin
    et al.
    Dellve, Lotta
    University of Borås, School of Health Science.
    Ahlborg, Gunnar jr
    A prospective study of managers' turnover and health in a healthcare organization.2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 7, p. 889-899Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess turnover and health of Swedish healthcare managers, and identify important supporting factors relating to work and individual resources. BACKGROUND: Individual managers' own sustainability in terms of turnover and health may be influenced by managerial working conditions and individual resources. METHODS: A 4-year prospective questionnaire study of 216 healthcare managers. Turnover and indicators of good health (healthy work attendance and no burnout) were related to work factors and individual resources using Cox regressions with constant time at risk. RESULTS: Forty per cent of the healthcare managers had left after 4 years. Fifty-two per cent had a healthy work attendance record and the proportion with no burnout had increased. Experiencing moderate/high job control was a predictor of remaining in the managerial position. Good health was predicted by having energy left for domestic work and being thoroughly rested after sleep. CONCLUSIONS: Managerial turnover seems high in Swedish healthcare and linked to working conditions, while sustained health are linked to individual resources. IMPLICATIONS FOR NURSING MANAGEMENT: Healthcare organizations should focus not only on developing individuals in their managerial role but also on strengthening the conditions that allow managers to exercise their leadership and to ensuring that the managers most suitable for their posts do not leave.

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