Logo: to the web site of Uppsala University

Background In Sweden, becoming a registered nurse with a Bachelor of Science degree in nursing requires three years of full-time study, including an independent 15-credit thesis. Nursing undergraduates have limited access to ongoing research projects and clinical settings, which often prioritize master's students and faculty-led studies. Thus, many nursing programs default to a literature-review norm, which reduces methodological diversity. This study focuses solely on non-traditional approaches, such as blog analyses, autobiographical analyses, and other innovative designs. The study seeks to disclose how these methods contribute to understanding patient experiences and advancing nursing education and research. Aim The aim of the study was to systematically map and critically analyze the methodological and theoretical diversity within Swedish bachelor's theses in nursing that employ alternative research methods. Method A scoping review was conducted. Searches were performed in the DiVA portal (title-only list of 22 145 records) and in three university repositories (2 861 records), followed by an abstract-inclusive DiVA search (491 records). Screening and full-text review yielded 380 final inclusions. The national digital science archive was used to access theses completed between 2013 and 2023. Descriptive and inferential statistics were employed to analyze the data. Results Autobiographical works were the most frequently used sources (n = 220), followed by blogs (n = 126). Dictionaries, internet forums, and combined sources were rare. Few theses used dictionaries, social media or internet forums. A descriptive research design was employed in most of the theses, and the majority focused on adults, primarily women. The theoretical content mainly covered themes related to existential issues and suffering, but several bachelor's theses lacked a formal theoretical framework. Conclusion Descriptive designs predominated, while exploratory and theory-integrated approaches were rare. Addressing these gaps requires pedagogical reforms that support use of diverse data sources and encourage inclusive research.

Moral distress among nurses is well researched and well documented, but there is limited research on the moral distress experienced by care leaders, who serve as intermediaries between patient care nurses and higher levels of administration. Healthcare professionals experience moral distress daily in the context of older adult care. The aim of this scoping review was to evaluate recent literature on moral distress in older adult care with the goal of revealing how care leaders’ experiences of moral distress in older adult care have been conceptualized in earlier studies. The research questions were: How is the concept of moral distress as experienced by care leaders in older adult care defined in the existing literature? How is the concept of moral distress conceptualized in the literature? The research has been conducted in accordance with the guidelines set forth by the Finnish National Advisory Board on Research Ethics TENK. We saw that consensus on how moral distress is defined is lacking. Care leaders in older adult care experience substantial moral distress, which could be linked to the duality of their leadership role. Moral distress can be caused by a complex interplay of individual and structural factors and the challenging complex moral issues inherent to older adult care. Moral distress could impact care leaders’ emotional health, job performance, overall job satisfaction and result in higher turnover rates, absenteeism, decreased quality of patient care, and increased organizational costs. Addressing moral distress on the individual, team, and organizational levels is crucial for enhancing care leaders’ well-being and improving the overall quality of care for older adults. A focus on the identification of strategies whereby care leaders can be supported, exploration of the long-term effects of moral distress on healthcare professionals in general, and the organizational outcomes associated with moral distress should be included in future research.

Background

Nurses work in a knowledge-intensive sector with high demands for lifelong learning. Thriving is a positive psychological state, including a sense of mutual learning and vitality at work. Research on thriving, its antecedents and outcomes is called for. The study aim was to examine thriving as a mediator in the relationships between telephone nurses’ structural empowerment and the outcomes work-personal life benefits, job performance, work-related stress symptoms and turnover intentions, as well as to psychometrically test the Thriving Scale (Swedish version).

Methods

Questionnaire data, a national sample of 409 Swedish telephone nurses, were collected, and relationships were examined using multiple regression analyses with PROCESS macro. Factorial validity of the Thriving Scale was tested using confirmative factor analyses.

Results

There were statistically significant relationships between structural empowerment and the outcomes (work-personal life benefits, job performance, stress symptoms, turnover intentions), and these relationships were mediated by thriving. The Thriving Scale showed good internal consistency, and an acceptable to borderline mediocre fit for factorial validity. Thirty-two percent reported turnover intentions.

Conclusions

Good access to structural empowerment increases nurses’ thriving, which in turn improves work-personal life benefits, job performance, and decreases stress symptoms and turnover intentions. Managers should strive to improve nurses’ thriving at work, emphasizing good access to empowering structures.

Purpose

The purpose of this paper is to describe first-line managers’ (FLMs’) experiences and reflections on structural conditions for management practice within hospital settings using Kanter’s theory of structural empowerment.

Design/methodology/approach

A qualitative deductive approach with a descriptive design was used. Interviews were conducted with 11 FLMs in charge of medical or surgical hospital units spread across Sweden. Data were analyzed using a directed content analysis, based on Kanter’s theory of structural empowerment, encompassing such as access to necessary and sufficient resources, information, support and opportunities to learn and develop.

Findings

Findings of this study from the FLMs’ descriptions and reflections shed light on the impact of power dynamics on the structural conditions for management practice. The availability of nursing staff was a fundamental resource in the FLMs’ work performance, ensuring delivery of care to patients and a sound work environment for staff. Additionally, the other structural elements outlined in Kanter’s theory were evident in the findings, as the FLMs wished for structured information flow, identified potential and challenged opportunities for development and emphasized the importance of receiving support from people with a genuine understanding of their work situation.

Originality/value

The results of this study contribute to the understanding of FLMs’ structural conditions for management practice in hospital settings. The paper’s originality stems from the use of a deductive approach, providing a structured lens with the potential to inform future research and practice in the field of health-care management.

Background

Leadership and access to structural empowerment are known to influence the work life experiences of staff and quality of care. Knowledge about relationships between specific factors of structural empowerment, leadership and management, staff well-being and quality of care at both an individual and unit level is scarce.

Aim

To study the relationship between staff-rated access to empowering structures, leadership and management performance, well-being, and quality of care in hospital settings measured at the individual level and aggregated at the unit level.

Methods

A cross-sectional correlative design was applied. Questionnaire data from 331 randomized hospital nursing staff working at 38 units in 25 hospitals in Sweden were analyzed using bivariate correlations and general estimation equation (GEE) models.

Results

Results from the bivariate analysis of relationships confirmed earlier research. In the GEE models, some unexpected results were found and differences between the individual and unit levels. Adding management and leadership as independent factors in the second model showed few relationships of significance to the outcome variables.

Conclusion

Results confirm the importance of staff access to empowering structures in relation to well-being and quality of care. Differences and similarities were shown when studying these relationships at both the individual and unit level. The findings feature implications for hospital management to promote staff access to empowering structures. The findings provide information on how these structures relate to the individual and the unit; information that could be useful when planning or implementing strategies with the aim to promote staff well-being and care quality. The non-significant results for leadership and management in relation to staff outcomes in the GEE-models, raise questions for further research where a shift from individual to organizational focused performances within the field of leadership is implied.

Aim The aim was to study how first-line managers act to make structural empowerment accessible for nursing staff and furthermore to relate these observations to the manager's and their nursing staff's descriptions regarding the staff's access to empowering structures.

Background Staff access to empowering structures has been linked to positive workplace outcomes. Managers play an important role in providing the conditions for structural empowerment.

Method Five first-line managers were observed for two workdays. Managers and staff (n = 13) were thereafter interviewed. Field notes and interviews were analysed using directed content analysis.

Results The managers displayed intentional actions that could enable their staff access to empowering structures. Managers and staff described the importance of staff's access to empowering structures.

Conclusion Staff who perceive to have access to structural empowerment have managers who are present and available. Unanimity among managers and staff existed in regard to the importance of staff having access to structural empowerment. The managers work continually and intentionally, doing many things at the same time, to provide the staff access to empowering structures. Implications for Nursing Management The study shows the importance of promoting managers' awareness of staff's access to structural empowerment and maximizing managers' presence and availability to their staff.

Aim To explore first-line managers' experiences of what Moral Case Deliberation has meant for daily practice, to describe perceptions of context influence and responsibility to manage ethically difficult situations. Background In order to find measures to evaluate Moral Case Deliberation, the European Moral Case Deliberation Outcome instrument was developed and is now in the stage of revision. For this, there is a need of several perspectives, one of them being the managerial bird-eye perspective. Method Eleven first-line managers at workplaces, participating in the European Moral Case Deliberation Outcome instrument project, were interviewed and thematic analysis was applied. Results Managers' experiences were interpreted as enhanced ethical climate: a closer-knit and more emotionally mature team, morally strengthened individuals, as well as ethics leaving its marks on everyday work and morally grounded actions. Despite organizational barriers, they felt inspired to continue ethics work. Conclusion and Implications This study confirmed, but also added ethical climate aspects, such as morally grounded actions. Furthermore, adding ethical climate as a construct in the European Moral Case Deliberation Outcome instrument should be considered. First-line managers need clear directives from their managers that ethics work needs to be prioritized for the good of both the staff and the patients.

Person-centred care has been shown to have positive outcomes for patients and for staff. However, the complexity of the link between structural conditions, work in a person-centred manner and outcomes for staff is insufficiently described. We tested the relationship between structural empowerment and psychological empowerment, as mediated by nursing home staff members' self-ratings of working in a person-centred manner, the person-centred climate and thriving. Questionnaires were distributed to staff working in 12 nursing homes in Sweden. A serial mediation model was tested. The results showed that higher access to structural empowerment was related to higher psychological empowerment mediated by staff working in a more person-centred manner, improved person-centred climate, and improved staff ratings of thriving. These results point to the importance of strengthening the preconditions for staff to work in a person-centred manner and nursing home managers play an important role in this.

Background: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain. Objective: To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces. Methods: A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority. Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation. Findings: Other than moral reasoning' (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of reflections on the psychosocial work environment' to a varying extent (md: 29%). Additional content comprised assumptions about the patient's psychosocial situation' (md: 6%), facts about the patient's situation' (md: 5%), concrete problem-solving' (md: 6%) and process' (md: 3%). Conclusion: The findings suggest that a restorative function of staff's wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants' own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

Background: During the nursing programme in Sweden, students complete an independent project that allows them to receive both a professional qualification as a nurse and a Bachelor's degree. This project gives students the opportunity to develop and apply skills such as critical thinking, problem-solving and decision-making, thus preparing them for their future work. However, only a few, small-scale studies have analysed the independent project to gain more insight into how nursing students carry out this task. Objectives: The aim of the present study was to describe the methods, including ethical considerations and assessment of data quality, applied in nursing students' independent Bachelor's degree projects in a Swedish context. Design: A descriptive study with a quantitative approach.

Methods: A total of 490 independent projects were analysed using descriptive statistics.

Results: Literature reviews were the predominant project form. References were often used to support the analysis method. They were not, however, always relevant to the method. This was also true of ethical considerations. When a qualitative approach was used, and data collected through interviews, the participants were typically professionals. In qualitative projects involving analysis of biographies/autobiographies or blogs participants were either persons with a disease or next of kin of a person with a disease.

Conclusions: Although most of the projects were literature reviews, it seemed unclear to the nursing students how the data should be analysed as well as what ethical issues should be raised in relation to the method. Consequently, further research and guidance are needed. In Sweden, independent projects are not considered research and are therefore not required to undergo ethics vetting. However, it is important that they be designed so as to avoid possible research ethics problems. Asking persons about their health, which occurred in some of the empirical projects, may therefore be considered questionable.