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Hagerman, H., Högberg, H., Skytt, B., Wadensten, B. & Engström, M. (2017). Empowerment and performance of managers and subordinates in elderly care: A longitudinal and multilevel study. Journal of Nursing Management, 25(8), 647-656
Open this publication in new window or tab >>Empowerment and performance of managers and subordinates in elderly care: A longitudinal and multilevel study
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2017 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 8, p. 647-656Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance.

BACKGROUND: Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers.

METHOD: In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services.

RESULTS: First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates.

CONCLUSIONS: Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance.

IMPLICATIONS FOR NURSING MANAGEMENT: Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

Keywords
first-line manager, leadership-management performance, linear mixed model, structural and psychological empowerment, subordinate
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-331770 (URN)10.1111/jonm.12504 (DOI)000414511300009 ()28714218 (PubMedID)
Funder
AFA Insurance
Available from: 2017-10-17 Created: 2017-10-17 Last updated: 2018-02-16Bibliographically approved
Lindberg, M., Lindberg, M. & Skytt, B. (2017). Risk behaviours for organism transmission in health care delivery-A two month unstructured observational study.. International Journal of Nursing Studies, 70, 38-45
Open this publication in new window or tab >>Risk behaviours for organism transmission in health care delivery-A two month unstructured observational study.
2017 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 70, p. 38-45Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Errors in infection control practices risk patient safety. The probability for errors can increase when care practices become more multifaceted. It is therefore fundamental to track risk behaviours and potential errors in various care situations.

OBJECTIVE: The aim of this study was to describe care situations involving risk behaviours for organism transmission that could lead to subsequent healthcare-associated infections.

DESIGN & SETTING: Unstructured nonparticipant observations were performed at three medical wards.

PARTICIPANTS & METHODS: Healthcare personnel (n=27) were shadowed, in total 39h, on randomly selected weekdays between 7:30 am and 12 noon. Content analysis was used to inductively categorize activities into tasks and based on the character into groups. Risk behaviours for organism transmission were deductively classified into types of errors. Multiple response crosstabs procedure was used to visualize the number and proportion of errors in tasks. One-Way ANOVA with Bonferroni post Hoc test was used to determine differences among the three groups of activities.

RESULTS: The qualitative findings gives an understanding of that risk behaviours for organism transmission goes beyond the five moments of hand hygiene and also includes the handling and placement of materials and equipment. The tasks with the highest percentage of errors were; 'personal hygiene', 'elimination' and 'dressing/wound care'. The most common types of errors in all identified tasks were; 'hand disinfection', 'glove usage', and 'placement of materials'. Significantly more errors (p<0.0001) were observed the more multifaceted (single, combined or interrupted) the activity was.

CONCLUSION: The numbers and types of errors as well as the character of activities performed in care situations described in this study confirm the need to improve current infection control practices. It is fundamental that healthcare personnel practice good hand hygiene however effective preventive hygiene is complex in healthcare activities due to the multifaceted care situations, especially when activities are interrupted. A deeper understanding of infection control practices that goes beyond the sense of security by means of hand disinfection and use of gloves is needed as materials and surfaces in the care environment might be contaminated and thus pose a risk for organism transmission.

Keywords
Hand hygiene, Healthcare-associated infections, Hygiene, Infection control
National Category
Nursing Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-317118 (URN)10.1016/j.ijnurstu.2017.02.016 (DOI)000399853700005 ()28231441 (PubMedID)
Available from: 2017-03-10 Created: 2017-03-10 Last updated: 2017-05-30Bibliographically approved
Skytt, B., Engström, M., Mårtensson, G. & Mamhidir, A.-G. (2016). A longitudinal qualitative study of health care personnel's perceptions of simultaneous implementation of three risk assessment scales on falls, malnutrition and pressure ulcers. Journal of Clinical Nursing, 25(13-14), 1912-1922
Open this publication in new window or tab >>A longitudinal qualitative study of health care personnel's perceptions of simultaneous implementation of three risk assessment scales on falls, malnutrition and pressure ulcers
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 13-14, p. 1912-1922Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: In this study, the aim was to understand health care personnel's expectations and experiences of participating in an intervention aimed at the implementation of three assessment scales for fall injuries, malnutrition and pressure ulcers, and the performance of preventive measures in these areas over the period of 18 months.

BACKGROUND: Fall injuries, malnutrition and pressure ulcers among older people are challenging issues for caregivers at different levels in the health care system.

DESIGN: A descriptive design with a qualitative approach was used to follow health care personnel before, during and after implementation of a care prevention intervention.

METHODS: Twelve health care personnel with different professions at the hospital, primary care and municipal care levels participated in a preventive care introduction. Seminars were held at four occasions, with assignments to be completed between seminars. Lectures and group discussions were performed, and three risk assessment scales were introduced. The participants were interviewed before, during and after the introduction. Manifest and latent content analysis were used.

RESULTS: The main results are presented in the theme 'Patient needs are visualised through a gradually developed shared understanding' and in five categories. The work approach of performing three risk assessments simultaneously was perceived as positive and central to ensuring quality of care; it was not, however, perceived as unproblematic.

CONCLUSION: The participants as well as health care team members showed a positive attitude towards and described the advantages of being given opportunities for shared understanding to improve patient safety and to provide structure for the provision of good care.

RELEVANCE TO CLINICAL PRACTICE: The managerial approach of listening to and acting on issues stressed by health care personnel is important to ensure ongoing and future improvement initiatives.

Keywords
interview; older people; risk assessments
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-284203 (URN)10.1111/jocn.13207 (DOI)000377214300010 ()27075599 (PubMedID)
Available from: 2016-04-15 Created: 2016-04-15 Last updated: 2017-11-30Bibliographically approved
Hagerman, H., Skytt, B., Wadensten, B., Högberg, H. & Engström, M. (2016). A longitudinal study of working life among first-line managers in the care of older adults. Applied Nursing Research, 32, 7-13
Open this publication in new window or tab >>A longitudinal study of working life among first-line managers in the care of older adults
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2016 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 32, p. 7-13Article in journal (Refereed) Published
Abstract [en]

Aim: To study whether the number of subordinates plays a role in first-line managers' and subordinates' ratings of empowerment, stress symptoms, and leadership-management performance. The aim was also to study relationships between managers' empowerment and stress symptoms and leadership-management performance. Methods: A longitudinal and correlational design was used. All first-line managers (n = 98) and their subordinates (n = 2085) working in the care of older adults in five municipalities were approached. Results: With fewer (<= 30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with >= 31 subordinates. Furthermore, structural empowerment was related to the managers' stress symptoms and leadership management performance, mediated through psychological empowerment Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms. Conclusion: The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership-management performance they rated over time.

Keywords
First-line manager, Leadership-management performance, Number of subordinates, Stress symptoms, Structural and psychological empowerment
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-310763 (URN)10.1016/j.apnr.2016.03.003 (DOI)000388057100002 ()27969055 (PubMedID)
Funder
AFA Insurance
Available from: 2016-12-19 Created: 2016-12-19 Last updated: 2017-11-29Bibliographically approved
Roos, C., Silén, M., Skytt, B. & Engström, M. (2016). An intervention targeting fundamental values among caregivers at residential facilities: effects of a cluster-randomized controlled trial on residents' self-reported empowerment, person-centered climate and life satisfaction. BMC Geriatrics, 16, Article ID 130.
Open this publication in new window or tab >>An intervention targeting fundamental values among caregivers at residential facilities: effects of a cluster-randomized controlled trial on residents' self-reported empowerment, person-centered climate and life satisfaction
2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 130Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In Sweden the national fundamental values for care of older people state that care should ensure that they can live in dignity and with a sense of well-being. Our hypothesis was that a caregiver intervention targeting the national fundamental values would improve perceived empowerment, person-centered climate and life satisfaction among older people living in residential facilities.

METHODS: The study was a cluster-randomized controlled trial with a pre- and one post-test design, conducted in 27 units (17 study units) at 12 residential facilities for older people in five municipalities in central Sweden. The units in each municipality were randomly assigned to intervention or control group. The caregiver intervention was carried out using an interpretative approach with eight guided face-to-face seminars, where self-reflection and dialogue were used. Data were collected using questionnaires. The number of residents was 43 (78 %) in the intervention group and 37 (71 %) in the control group. The Chi-square test and Mann-Whitney U-tests were performed to detect differences between groups and Wilcoxon signed rank tests to explore differences in change over time within groups. Furthermore, generalized estimating equation (GEE) models were used to study effects of the intervention controlling for clustering effects.

RESULTS: Primary outcome measures were empowerment, person-centered climate and life satisfaction. In the intervention group, improvements at follow-up were found in residents' self-reported empowerment (n = 42; p = 0.001, Median difference 4.0, 95 % CI 1.5;6.0), person-centered climate (n = 42; p ≤0.001, Median difference 8.0, 95 % CI 4.5;11.4) and life satisfaction regarding the factor quality of everyday activities (n = 40; p = 0.033, Median difference 9.7, 95 % CI 1.0;21.9) while disempowerment decreased (n = 43; p = 0.018, Median difference -1.3, 95 % CI -2.0;0.0). In the control group person-centered climate decreased (n = 37; p = 0.002, Median difference -8.5, 95 % CI -13.6;-3.0) and quality of everyday activities (n = 36; p = 0.012, Median difference -11.6, 95 % CI-21.7;-3.4). Change over time between groups was significant for empowerment (p = 0.001, Median difference 6.0, 95 % CI 3.0;9.0), disempowerment (p = 0.006, Median difference -2.0, 95 % CI -4.0;-1.0) and person-centered climate (p ≤ 0.001, Median difference 16.0, 95 % CI 9.7;23.0) and for life satisfaction regarding the factor quality of everyday activities (p = 0.002, Median difference 22.1, 95 % CI 8.2;37.4). Results of GEE confirmed earlier results; revealed interaction effects for empowerment (parameter estimate -5.0, 95 % CI -8.3;-1.8), person-centered climate (parameter estimate -16.7, 95 % CI -22.4;-10.9) and life satisfaction regarding the factor quality of everyday activities (parameter estimate -25.9, 95 % CI -40.3;-11.5).

CONCLUSION: When the Swedish national fundamental values were put into practice increases in empowerment, person-centered climate and quality of everyday activities were found among older people with intact cognitive ability living in residential facilities. Limitations to consider are the differences between the two groups at baseline, drop-outs and that neither the data collector nor the outcome assessors were blinded to group assignment of participants.

TRIAL REGISTRATION: The study was registered in ISRCTN92658034 in January 2013.

Keywords
Empowerment; Experimental design; Living in dignity; Person-centered climate; Residential facilities for older people; A sense of well-being; Life satisfaction
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-299145 (URN)10.1186/s12877-016-0306-2 (DOI)000379253200003 ()27387954 (PubMedID)
Available from: 2016-07-14 Created: 2016-07-14 Last updated: 2017-11-28Bibliographically approved
Skytt, B., Hagerman, H., Strömberg, A. & Engström, M. (2015). First-line managers' descriptions and reflections regarding their staff's access to empowering structures. Journal of Nursing Management, 23(8), 1003-1010
Open this publication in new window or tab >>First-line managers' descriptions and reflections regarding their staff's access to empowering structures
2015 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 8, p. 1003-1010Article in journal (Refereed) Published
Abstract [en]

AIM: To elucidate first-line managers' descriptions and reflections regarding their staff's access to empowering structures using Kanter's theory of structural empowerment.

BACKGROUND: Good structural conditions within workplaces are essential to employees' wellbeing, and their ability to access empowerment structures is largely dependent on the management.

METHOD: Twenty-eight first-line managers in elderly care were interviewed. Deductive qualitative content analysis was used to analyse data.

RESULTS: Managers perceived that staff had varying degrees of access to the empowering structures described in Kanter's theory - and that they possessed formal power in their roles as contact persons and representatives. The descriptions mostly started from the managers' own actions, although some started from the needs of staff members.

CONCLUSION: All managers described their staff's access to the empowering structures in Kanter's theory as important, yet it seemed as though this was not always reflected on and discussed as a strategic issue.

IMPLICATIONS FOR NURSING MANAGEMENT: Managers could make use of performance and appraisal dialogues to keep up to date on staff's access to empowering structures. Recurrent discussions in the management group based on such current information could promote staff's access to power through empowering structures and make job definitions a strategic issue in the organisation.

Keywords
elderly care; first-line managers; staff; structural empowerment
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-244390 (URN)10.1111/jonm.12246 (DOI)000368261600006 ()25059511 (PubMedID)
Funder
AFA Insurance
Available from: 2015-02-16 Created: 2015-02-16 Last updated: 2017-12-04Bibliographically approved
Hagerman, H., Engström, M., Häggström, E., Wadensten, B. & Skytt, B. (2015). Male first-line managers' experiences of the work situation in elderly care: an empowerment perspective. Journal of Nursing Management, 23(6), 695-704
Open this publication in new window or tab >>Male first-line managers' experiences of the work situation in elderly care: an empowerment perspective
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2015 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 6, p. 695-704Article in journal (Refereed) Published
Abstract [en]

AIM: To describe male first-line managers' experiences of their work situation in elderly care.

BACKGROUND: First-line managers' work is challenging. However, less attention has been paid to male managers' work situation in health care. Knowledge is needed to empower male managers.

METHOD: Fourteen male first-line managers were interviewed. The interview text was subjected to qualitative content analysis.

RESULT: Work situations were described as complex and challenging; challenges were the driving force. They talked about 'Being on one's own but not feeling left alone', 'Having freedom within set boundaries', 'Feeling a sense of satisfaction and stimulation', 'Feeling a sense of frustration' and 'Having a feeling of dejection and resignation'.

CONCLUSION: Although the male managers report deficiencies in the support structure, they largely experience their work as a positive challenge.

IMPLICATIONS FOR NURSING MANAGEMENT: To meet increasing challenges, male first-line managers need better access to supportive structural conditions. Better access to resources is needed in particular, allowing managers to be more visible for staff and to work with development and quality issues instead of administrative tasks. Regarding organisational changes and the scrutiny of management and the media, they lack and thus need support and information from superiors.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-244392 (URN)10.1111/jonm.12197 (DOI)000360840300002 ()24283766 (PubMedID)
Available from: 2015-02-16 Created: 2015-02-16 Last updated: 2017-12-04Bibliographically approved
Lindberg, M., Carlsson, M. & Skytt, B. (2014). MRSA-colonized persons' and healthcare personnel's experiences of patient-professional interactions in and responsibilities for infection prevention in Sweden. Journal of infection and public health, 7(5), 427-435
Open this publication in new window or tab >>MRSA-colonized persons' and healthcare personnel's experiences of patient-professional interactions in and responsibilities for infection prevention in Sweden
2014 (English)In: Journal of infection and public health, ISSN 1876-035X, Vol. 7, no 5, p. 427-435Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Patient-professional interactions and adherence to infection control measures are central to the quality of care and patient safety in healthcare. Persons colonized with methicillin-resistant Staphylococcus aureus (MRSA) describe insufficient support and unprofessional behavior among healthcare personnel.

METHODS:

A descriptive qualitative study was conducted to investigate managers', physicians', registered nurses' and MRSA-colonized persons' experiences of patient-professional interactions in relation to and responsibilities for infection prevention in the care of colonized patients. Five persons with MRSA colonization and 20 healthcare personnel employed within infection, hematology, nephrology or primary healthcare settings participated. The data were collected using open-ended semi-structured individual interviews with the MRSA-colonized persons and semi-structured focus group interviews with the healthcare personnel.

RESULTS:

The participants perceived MRSA as an indefinable threat and described that the responsibility for infection prevention is important, but such adherence was a neglected and negotiable issue. The described actions that were acknowledged as unprofessional and inappropriate adherence to infection prevention resulted in stigmatized patients.

CONCLUSION:

Colonized persons' and healthcare personnel's understanding of MRSA determines whether the personnel's behavior is perceived as proper or improper. Individual responsibility for patient-professional interactions in relation to MRSA colonization and adherence to infection control measures should be more stringent.

National Category
Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-232532 (URN)10.1016/j.jiph.2014.02.004 (DOI)000354964000009 ()24888790 (PubMedID)
Available from: 2014-09-19 Created: 2014-09-19 Last updated: 2015-06-24Bibliographically approved
Swenne, C. L. & Skytt, B. (2014). The ward round--patient experiences and barriers to participation. Scandinavian Journal of Caring Sciences, 28(2), 297-304
Open this publication in new window or tab >>The ward round--patient experiences and barriers to participation
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 297-304Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Patients' participation is essential to their well-being and sense of coherence, as well as to their understanding of and adherence to prescribed treatments. Ward rounds serve as a forum for sharing information between patient and caregiver. The purpose of the ward round is to obtain information and plan medical and nursing care through staff-patient communication.

AIM AND OBJECTIVE:

The aim and objective of this study was to investigate patients' experiences during the ward round and their ability to participate in their care.

METHODOLOGICAL DESIGN AND JUSTIFICATION:

The study was qualitative and descriptive in design. Fourteen inpatients at a cardiovascular ward were interviewed. Qualitative content analysis was used for the analysis.

ETHICAL ISSUES AND APPROVAL:

The ethics of scientific work were adhered to. Each study participant gave his/her informed consent based on verbal and written information. The study was approved by the Research Ethics Committee at Uppsala University.

RESULTS:

The analysis revealed one theme and three subthemes related to patients' experiences of ward rounds. The main theme was handling of information from the daily ward round while waiting for private consultation. The subthemes were making the best of the short time spent on ward rounds; encountering traditional roles and taking comfort in staff competency; and being able to choose the degree to which one participates in the decision-making process.

CONCLUSIONS:

Several aspects of traditional ward round routines could be improved in regard to the two-way information exchange process between caregivers and patient. Patients' and caregivers' ability to communicate their goals and the environment in which the communication occurs are of great importance. The information provided by nurses is easier to understand than that provided by physicians. The atmosphere must be open; the patient should be treated with empathy by staff; and patients' right to participate must be acknowledged by all healthcare professionals involved.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-237556 (URN)10.1111/scs.12059 (DOI)000334503400011 ()
Available from: 2014-12-03 Created: 2014-12-03 Last updated: 2017-12-05Bibliographically approved
Engström, M., Skytt, B., Ernesater, A., Flackman, B. & Mamhidir, A.-G. (2013). District nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management. Applied Nursing Research, 26(4), 198-203
Open this publication in new window or tab >>District nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management
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2013 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 26, no 4, p. 198-203Article in journal (Refereed) Published
Abstract [en]

Aim: To describe district nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management; and to examine associations between the variables. Background: Obesity is increasing worldwide and primary care could play a central role in the management. Methods: Questionnaire data were collected from 247 nurses in 33 centres. Results: The most common activities performed weekly were; advice about physical activity (40.1%) and general lifestyle advice (34.8%). However, nearly one third seldom/never performed these activities. Approximately half seldom/never performed BMI assessment and even fewer waist circumference (78.1%). Values for the factors Importance of obesity and Personal effectiveness were skewed towards a positive view and Negative view close to neutral. Multivariate analysis revealed that nurses with specialized tasks, longer working experience and higher perceived personal effectiveness performed more clinical activities. Conclusion: Managers need to make efforts to engage all personnel in obesity management; and strategies to increase self-efficacy are called for.

Keywords
Attitudes, Beliefs, District nurses, Obesity management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-213933 (URN)10.1016/j.apnr.2013.06.009 (DOI)000327804900008 ()
Available from: 2014-01-05 Created: 2014-01-05 Last updated: 2017-12-06
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