Moniulotteinen hoitotyön johtajuus ja hoitohenkilöstön työuupumus terveydenhuollossa

Abstract The purpose of the study was to examine the relationship between nursing leadership and burnout among nurses in health care as well as the incidence of multidimensional leadership and burnout in Finnish nursing. A further purpose was to test a factor structure of Multifactor Leadership Questionnaire (MLQ) and Maslach Burnout Inventory (MBI) in Finnish health care. The empirical data were gathered by postal questionnaires from nursing staff working in university, central and district hospitals, health centers as well as psychiatric and private hospitals (n = 900, response rate 73%). In addition, a follow-up study was performed at a one-year interval (n = 100, response rate 79%). After deleting unusable questionnaires, the sample consisted of 627, and the follow-up study of 78 nurses and nurse leaders. The data were analyzed with descriptive and multivariate statistical methods. Nurse leaders proved to be transformational leaders who rewarded their subordinates, but traditional active and passive management-by-exception and laissez-faire leadership also appeared in their leadership behavior. Half of the nursing staff were moderately burned out and about one tenth were highly burned out. Nearly one fifth suffered from high emotional exhaustion. Nursing leadership has both positive and negative effects on burnout among nursing staff. Rewarding transformational leadership and active management-by-exception functioned as protecting factors, and passive laissez-faire leadership as an exposing factor. However, the results suggest that the relation between leadership and burnout is complex, affected by situational factors of leadership and the ambiguous nature of burnout. The six- and three-factor structure of the MLQ as well as the three-factor structure of the MBI were empirically supported. According to psychometric properties both instruments are well applicable to Finnish health care research. The results can be used in academic leadership education and leadership training in health care organizations, as well as to improve the quality of work life and to promote work well-being. The results can also be utilized in studies applying MLQ and MBI as well as when exploring factor structure of measures and in validation studies of instruments.Tiivistelmä Tutkimuksen tarkoituksena oli selvittää hoitotyön johtajuuden ja hoitohenkilöstön työuupumuksen yhteyttä terveydenhuollossa sekä moniulotteisen johtajuuden ja työuupumuksen esiintymistä suomalaisessa hoitotyössä. Lisäksi tarkoituksena oli testata suomalaisessa terveydenhuollossa moniulotteisen johtajuusmittarin ja kolmiulotteisen työuupumusmittarin rakennetta. Empiirinen tutkimusaineisto kerättiin postikyselyllä yliopisto-, keskus- ja aluesairaaloiden, terveyskeskusten sekä psykiatristen ja yksityisten sairaaloiden hoitohenkilöstöltä (n = 900, vastausprosentti 73). Lisäksi toteutettiin seurantakysely vuoden intervallilla (n = 100, vastausprosentti 79). Aineistosta jouduttiin poistamaan vastauksia, ja poistojen jälkeen tutkimusjoukko muodostui 627:stä ja seurantakyselyssä 78 hoitajasta ja hoitotyön esimiehestä. Aineiston analyysissä käytettiin tilastollisina kuvailevina menetelminä ristiintaulukointia, kontingenssikerrointa, χ²-testiä, Pearsonin tulomomenttikorrelaatiokerrointa, t-testiä, Mann-Whitney U-testiä, Wilcoxonin testiä, yksi- ja kaksisuuntaista varianssianalyysiä sekä Kruskal-Wallisin testiä. Monimuuttujamenetelminä olivat rakenneyhtälömallitus ja lineaarinen regressioanalyysi. Mittareiden luotettavuuden arvioinnissa käytettiin eksploratiivista ja konfirmatorista faktorianalyysiä, Cronbachin alpha -kerrointa, osiosummakorrelaatioita, osioiden välisiä korrelaatioita, Pearsonin tulomomenttikorrelaatiokerrointa ja intraclass-korrelaatiokerrointa. Hoitotyön johtajat osoittautuivat työntekijöitä palkitseviksi muutosjohtajiksi, mutta johtamiskäyttäytymisessä esiintyi myös perinteistä työntekijöiden aktiivista ja passiivista valvomista sekä välttävää johtajuutta. Eroja ilmeni johtajan iän, työkokemuksen, työtehtävän ja perustyöhön osallistumisen mukaan. Puolella hoitohenkilöstöstä esiintyi keskimääräistä ja noin kymmenesosalla voimakasta työuupumusta. Voimakkaasta emotionaalisesta väsymyksestä kärsi lähes joka viides. Hoitotyön johtajuudella on sekä myönteisiä että kielteisiä vaikutuksia hoitohenkilöstön työuupumuksen kannalta. Palkitseva muutosjohtajuus ja työntekijöiden aktiivinen valvominen toimivat työuupumukselta suojaavina tekijöinä ja passiivinen välttäminen työuupumukselle altistavana tekijänä. Tulokset viittaavat kuitenkin siihen, että johtajuuden ja työuupumuksen yhteys on kompleksinen, ja tähän vaikuttavat johtajuuden tilannetekijät ja työuupumuksen moniselitteinen luonne. Hoitohenkilöstön ikä, työllisyystilanne, työaikamuoto ja työtehtävän luonne vaikuttivat johtajuuden ja työuupumuksen yhteyteen, joka oli suhteellisen pysyvä vuoden intervallilla mitattuna. Myös johtajuus ja työuupumus osoittautuivat stabiileiksi ilmiöiksi. Johtajuusmittarin kuuden ja kolmen faktorin rakenne sekä työuupumusmittarin kolmen faktorin rakenne saivat empiiristä tukea. Mittareita voidaan pitää psykometristen ominaisuuksiensa perusteella suomalaiseen terveydenhuoltotutkimukseen soveltuvina. Tutkimustuloksia voidaan hyödyntää terveydenhuoltoalan yliopistollisessa ja terveydenhuollon organisaatioiden sisäisessä johtamiskoulutuksessa, työelämän laadun parantamisessa ja työhyvinvoinnin edistämisessä, johtajuus- ja työuupumusmittaria soveltavissa tutkimuksissa sekä laajemmin mittareiden kehittämistyössä ja validointitutkimuksissa

Subjective unmet needs for school health services among adolescents with different disabilities:a population-based study in Finland

Abstract Background: Subjective perceptions of unmet needs for health services among adolescents with different disabilities remain largely unstudied, even though various international conventions on the rights of people with disabilities oblige signatory governments to improve the equality of access to services. Aims: The aim the study was to examine the need for, and accessibility to, support and help from school health services among adolescents with different disabilities. A second aim was to determine whether these unmet needs are related to certain sociodemographic factors. Methodology: A nationwide, population-based cross-sectional study design was used. The data were collected from the 2017 School Health Promotion study in Finland. The study population consisted of 72,994 8th and 9thgrade adolescents (aged 14–16) who responded to a web survey, reflecting a response rate of 63%. The data were analyzed by cross-tabulation, chi-square tests and logistic regression. Results: The most common self-reported disabilities among adolescents were difficulties in remembering and learning (6–7%). However, a troubling 18–29% of adolescents with major difficulties reported that they had needed support from a school health nurse but had not received it. Moreover, 26–36% of adolescents with difficulties who had needed support from a physician had not received it. Adolescents with disabilities have approximately two- or three-fold higher risks of unmet needs than adolescents without disabilities. Adolescents with difficulties concentrating showed an over three-fold higher risk for unmet needs than other adolescents. The identified differences were evident even after sociodemographic factors were controlled for. Conclusions: Disabled adolescents may well have more health needs than other adolescents, and some of these needs may be unidentified. Thus, disabled adolescents may not receive the support and help they require. In this respect, there are challenging differences between adolescents with and without disabilities

Huono johtaminen:ja hyvät uutiset

Tiivistelmä Huono johtaminen lisää terveysalan henkilöstön irtisanoutumisaikomuksia eli karkottaa ihmisiä alalta tehokkaasti. Hyvä uutinen on, että kehittämällä johtamista henkilöstön työuria voidaan pidentää

Leadership in the context of digital health services:a concept analysis

Abstract Aim: To define and clarify the concept of leadership in the context of digital health services using Walker’s and Avant’s concept analysis model. Background: Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research. Method: Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO) and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents or consequences of leadership in the study context. A total of 4037 references were identified; 23 were included. Results: Leadership attributes concerned leaders’ behaviour, roles and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity and education. Consequences related to organization, professionals and patient and care. Conclusion: Based on our results, the term ’leadership’ should be more widely utilized in nursing practice and research. Implications for nursing management: Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth and benefit clinicians and patients

Toimintarajoitteisilla nuorilla tyydyttämätöntä tuen ja avun tarvetta koulu- ja opiskeluterveydenhuollosta

Tiivistelmä Kansainväliset lapsen ja vammaisten henkilöiden oikeuksia koskevat yleissopimukset velvoittavat parantamaan toimintarajoitteisten nuorten mahdollisuuksia saada palveluja yhdenvertaisesti. Tässä tutkimuksessa tarkasteltiin nuorten tuen ja avun tarvetta ja saantia terveydenhoitajalta ja lääkäriltä toimintarajoitteisilla ja muilla nuorilla sekä erityisesti tyydyttämätöntä tuen ja avun tarvetta sosiodemografisten tekijöiden mukaan. Tutkimuksessa käytettiin valtakunnallisen Kouluterveyskyselyn 2017 aineistoa (n=138 972). Aineisto analysoitiin ristiintaulukoinnilla, χ2-merkitsevyystestillä ja logistisella regressioanalyysillä. Noin 14 prosenttia nuorista arvioi, että heillä oli jokin vakava toimintarajoite eli vaikeuksia näkemisessä, kuulemisessa, liikkumisessa, muistamisessa, oppimisessa tai keskittymisessä. Nuorista, jotka ilmoittivat tarvinneensa tukea ja apua terveydenhoitajalta, kymmenesosa (10%) ei ollut sitä saanut. Tyydyttämätön tuen ja avun tarve oli yleisempää toimintarajoitteisilla (19%) kuin muilla (9%) nuorilla. Lääkäriltä tukea ja apua tarvinneista nuorista noin joka kuudes (16%) ei ollut saanut sitä. Tyydyttämätön tuen ja avun tarve oli yli kaksi kertaa yleisempää toimintarajoitteisilla nuorilla (28%) muihin nuoriin verrattuna (13%). Toimintarajoitteisilla nuorilla oli yli kaksinkertainen riski jäädä ilman tarvitsemaansa tukea ja apua muihin nuoriin verrattuna tarkasteltaessa sekä terveydenhoitajalta että lääkäriltä saatavaa tukea ja apua, vaikka sosiodemografiset tekijät vakioitiin. Toimintarajoitteisilla nuorilla on muita nuoria enemmän hyvinvointiin ja terveyteen liittyviä tuen tarpeita, joista osa voi jäädä tunnistamatta, ja nuori voi kokea jäävänsä ilman tukea ja apua. Erot toimintarajoitteisten ja muiden nuorten välillä ovat suuria, mikä on haaste yhdenvertaisuuden toteutumiselle. Koulu- ja opiskeluterveydenhuollolla on keskeinen rooli näiden hyvinvointierojen kaventamisessa ja yhdenvertaisuuden edistämisessä

Health and social care frontline leaders’ perceptions of competence management in telemedicine in Finland:an interview study

Abstract Aim: This work aims to describe competence management in telemedicine from the perspective of health and social care frontline leaders. Background: The increasing use of services in health and social care is a challenging aspect of modern telemedicine; it requires staff to develop relevant professional competence and good telemedicine practices. Methods: The study was conducted using thematic interviews of frontline leaders from primary health care, specialized medical care and social care (n = 10) in the spring of 2021. The data were analysed by inductive content analysis. Results: The following main categories were identified: Activities of frontline leaders while managing competence in telemedicine, promotion of community learning, competence management in determining telemedicine content, and recognizing health and social care professionals’ competence in telemedicine. Conclusions: Achieving the goals set for telemedicine requires ensuring that knowledge from leaders is widely disseminated and shared and that staff are adequately trained. The results can be utilized in the practical work of other telemedicine and in the development of their operations. Implications for Nursing Management: Managing competence in telemedicine requires from the leaders an encouraging attitude and improved personal interactions in the work community

Nurse leaders’ and digital service developers’ perceptions of the future role of artificial intelligence in specialized medical care:an interview study

Abstract Aim: To describe nurse leaders’ and digital service developers’ perceptions of the future role of artificial intelligence (AI) in specialized medical care. Background: Use of AI has rapidly increased in health care. However, nurse leaders’ and developers’ perceptions of AI and its future in specialized medical care remain under-researched. Method: Descriptive qualitative methodology was applied. Data were collected through six focus groups, and interviews with nurse leaders (n = 20) and digital service developers (n = 10) conducted remotely in 2021 at a university hospital in Finland. The data were subjected to inductive content analysis. Results: The data yielded 25 sub-categories, 10 categories and three main categories of participants’ perceptions. The main categories were designated AI transforming: work, care and services and organizations. Conclusions: According to our respondents, AI will have a significant future role in specialized medical care, but it will likely reinforce, rather than replace, clinicians or traditional care. They also believe that it may have several positive consequences for clinicians’ and leaders’ work as well as for organizations and patients. Implications for nursing management: Nurse leaders should be familiar with the potential of AI, but also aware of risks. Such leaders may provide betters support for development of AI-based health services that improve clinicians’ workflows

Nurse leaders’ perceptions of future leadership in hospital settings in the post-pandemic era:a qualitative descriptive study

Abstract Purpose: Coronavirus disease (COVID-19) has challenged leadership in hospitals worldwide. The experiences of leadership during the pandemic changed leadership significantly. This study aims to describe nurse leaders’ perceptions of what future leadership in hospital settings in the post-pandemic era needs to be like. Design/methodology/approach: A qualitative descriptive study was used. A total of 20 nurse leaders from the Finnish central hospital were interviewed from June to October 2021. The data were analysed using inductive content analysis. Findings: The analysis revealed five main categories describing nurse leaders’ perceptions of future leadership in hospital settings in the post-pandemic era: digitalisation and hybrid working culture, development of sustainable working conditions, moving smoothly to the post-pandemic era, dissolution of traditional regimes of organisation and flexibility in leadership. Practical implications: In the post-pandemic era, the constantly changing demands and challenges currently facing healthcare systems have significantly increased the complexity of hospital organisations. This requires critical evaluation and change to traditional leadership. Enhancing flexibility and authenticity in leadership, strengthening competencies, implementing a wide range of digital resources and increasing the appeal of the nursing profession to build the next generation of nurses — all of these are needed to provide sustainability in future healthcare. Originality/value: The results identify the critical points of leadership that need to be developed for future challenges and for maintaining a sufficient supply of qualified professionals. Acting on this information will enhance flexibility in organisations and lead to acceleration of changes and the development of new kinds of leadership in the future

The roles of primary care middle managers in the implementation of eHealth in Finland:a qualitative interview study

Abstract Background: Healthcare middle managers play a critical role in the implementation of innovations as their actions and behaviours affect the success of implementation. Nevertheless, healthcare middle managers’ experiences of their involvement in eHealth implementation remain an understudied topic. Aim: To describe and understand primary care middle managers’ roles in eHealth implementation. Methods: A descriptive qualitative interview study was conducted. A total of 10 Finnish primary care middle managers were interviewed in 2020. The data were analysed through inductive content analysis. Findings: Primary care middle managers in Finland perform tasks that fall under support, implementation advancement, managerial, and informational roles. The interactions between these roles may be highly complex when the implementation is part of a national scheme involving numerous organisations. Conclusions: A clear, comprehensive understanding of the roles of middle managers, as well as the linkages between these roles, is critical to creating best practices for eHealth implementation

Patients’ experiences of patient-centred care in hospital setting:a systematic review of qualitative studies

Abstract Background: Patient-centred care (PCC) has been proposed as an appropriate approach for addressing current shifts in healthcare needs. Although the importance of PCC is generally recognised, PCC is poorly understood by patients in the hospital settings. Objectives: To identify patients’ experiences of PCC in hospital settings. Methodological design: This systematic review followed the Joanna Briggs Institute’s (JBI) guidance for systematic reviews of qualitative evidence and the PRISMA checklist for reporting systematic reviews. The search strategy included peer-reviewed qualitative studies published after 2010 in English or Finnish. The databases searched were SCOPUS, MEDLINE, CINAHL and Medic. Unpublished studies and grey literature were searched in MedNar. Ten qualitative studies were included, and their quality was assessed by two independent reviewers using JBI quality assessment criteria. The data were analysed using thematic analysis. Setting and participants: Studies were included if they had explored adult patient experiences of PCC in hospital settings. Results: A thematic analysis produced 14 subthemes which were grouped into five analytical themes: the presence of the professional, patient involvement in care, receiving information, the patient–professional relationship and being seen as a person. Conclusions and implications: This review suggests that the implementation and provision of PCC in hospitals is incomplete and patients’ involvement in their own care should be in the focus of PCC. The majority of patients experienced receiving PCC, but others did not. The need for improvement of patient involvement was strongly emphasised. Patients highlighted the importance of professionals being present and spending time with patients. Patients felt well-informed about their care but expressed the need for better communication. Meaningful patient–professional relationships were brokered by professionals demonstrating genuine care and respecting the patient as an individual. To improve the implementation of PCC, patient experiences should be considered in the development of relevant hospital care strategies. In addition, more training in PCC and patient–professional communication should be provided to health care professionals