Between being and doing - the nature of leadership of first-line nurse managers and registered nurses.

AIMS AND OBJECTIVES: The aim of this study was to describe first-line nurse managers' (F-LNMs) and subordinate registered nurses' (RNs) conceptions and experiences of their routine work and how leadership was exercised. BACKGROUND: Extensive changes in health care organisations have had a powerful impact on leadership in nursing management. Nursing leadership, in turn, has an affect on both the quality of care and the subordinates' work environment. Therefore, it is important to enhance our understanding of current leadership in nursing management. DESIGN: This is a descriptive qualitative study carried out in three units at three Swedish hospitals. METHODS: Three F-LNMs and 14 RNs participated. Interviews were used to collect data. The interviews were analysed using qualitative content analysis. RESULTS: The result of this study was illustrated in one main theme referred to in this study as between being and doing. The RNs and F-LNMs described what it was to be a good professional (being), how they were engaged in creating a good work climate (doing) and personal outcomes of this project (gaining). CONCLUSION: The reciprocal relation between being and doing, which can be described as the development of virtues, was a central point in the professional work of the F-LNMs and RNs. The development of virtues is also a strategy to attain the goals of nursing and establish a work climate that motivates staff and improves performance. RELEVANCE TO CLINICAL PRACTICES: The implication for nursing management is to create ample space to develop strategies and knowledge about how leadership in nursing management can stimulate the development of a common perspective of good care and professional virtues appropriate for health care praxis.

Rosen Method Bodywork: an exploratory study of an uncharted complementary therapy.

OBJECTIVES: This exploratory study examines the Rosen Method Bodywork (RMB), a complementary (CAM) therapy method that previously lacked scientific documentation. The objectives of this study were to describe (1) why clients consult RMB and (2) what kind of help or benefit (if any) the clients perceive. METHODS: The study comprised a survey of 53 Swedish RMB clients sampled from therapists, based on a criterion of personal experience of the therapy method, responding to a questionnaire collecting both qualitative and quantitative data. The quantitative data were analyzed descriptively and the qualitative data were analyzed by applying content analysis. RESULTS: Reasons to use the therapy method included physical health problems, psychological problems, and a need for personal growth. A majority of the clients reported that the therapy had helped them with their problems to "a very high" or "high" degree. The main finding is five different categories describing the benefits: enhanced psychological health, enhanced physical health, increased awareness of the mind-body connection, support for personal growth, and self-initiated life changes. CONCLUSIONS: Most RMB clients in this study indicated satisfaction with the treatment. The perceived benefits were found to be related to five separate categories. However, the results of this exploratory study cannot be generalized to a target population or to any conclusions about causality, as there is reason to assume that clients with positive experiences were overrepresented in the study population, due to the selection procedure. The results indicate that an analysis focusing on the interaction between client and therapist from a nursing theoretical perspective may increase the knowledge about mechanisms that create perceived benefits, since several aspects of the therapy seem to be related to high-quality nursing.

Rehabilitation nurses practices in relation to urinary incontinence following stroke: a cross-cultural comparison.

AIM: To explore nurses' practices and influences in relation to urinary incontinence following stroke, in the UK, Sweden and China. BACKGROUND: Urinary incontinence following stroke is common, under-recognised and poorly researched. Before appropriate rehabilitation interventions can be developed, an understanding of nurses' current management approaches and cultural influences is required. DESIGN: Qualitative. METHODS: Semi-structured interviews were undertaken with ten registered nurses from at least four different stroke units in three countries (n = 30). Interviews were carried out in the participants' first language, using an agreed interview guide. Following translation, thematic analysis focusing on manifest meaning was undertaken, using an iterative approach involving electronic and face-to-face discussions. RESULTS: The consequence of only superficial assessment was no systematic identification of types or causes of urinary incontinence and no individualised plans developed. A process model of practice, common to all three countries, was identified for stroke survivors with urinary incontinence. Routine core activities were followed by the palliative pathway (most frequently), where urinary incontinence was contained to protect the stroke survivors' safety and ensure social continence; or the rehabilitative route (more rarely), where simple continence promoting activities were implemented with the purpose of facilitating recovery of bladder function. CONCLUSIONS: Nurses' reactively manage urinary incontinence following stroke, adopting a routinised approach based on local custom and practice. Promotion of urinary continence is not a priority area of stroke rehabilitation for nurses in western or eastern countries. RELEVANCE TO CLINICAL PRACTICE: The dearth of evidence-based interventions available to rehabilitate bladder function following stroke means that stroke nursing practice is an experience-based endeavour. This study explains the nurses' focus on containment and social continence and highlights the need to systematically assess stroke survivors' bladder rehabilitation needs, identify types of urinary incontinence and adopt appropriate urinary continence promoting practices.

Patient's self-determination in intensive care-from an action- and confirmation theoretical perspective. The intensive care nurse view.

When becoming an intensive care patient life changes dramatically. In order to save life, different actions are performed by the caregivers and the patient's ability to exercise self-determination is non-existent. After the acute phase the patient is more awake and the possibilities for self-determination change. The purpose of this study was to describe intensive care nurses' (ICNs) views of patient's self-determination in an intensive care unit and to systematize ICNs' nursing actions for supporting patient's self-determination from an action- and confirmation-theoretic perspective. In order to answer these questions, 17 interviews with ICNs were conducted by the use of the Critical Incident Technique (CIT). The transcripts were then analysed using a hermeneutic analysis method and structured by the SAUC model for confirming nursing. The main findings were that the ICN thought that the ICU patient's self-determination was low and restricted. It was more common that the ICN acted to strengthen the patient's self-determination in nursing care, but there were no specific nursing goals for patient's self-determination. The most common actions for supporting self-determination were supplying the patient with information and engaging the patient in making a day plan. The nursing implications are that the ICN's view of human being as an acting subject is important for the ICN's awareness to recognise the patient's own personal resources to handle the critically ill situation and that the ICN's competence to manifest qualified nursing is necessary for strengthening patient's self-determination.

Psychiatric nursing care of suicidal patients described by the Sympathy-Acceptance-Understanding-Competence model for confirming nursing.

Our aim was to describe psychiatric nursing care of suicidal patients from an action-theoretical and confirmatory perspective using the Sympathy-Acceptance-Understanding-Competence (SAUC) model for confirming nursing. Twenty-nine nurses were interviewed and asked to answer a questionnaire. The interview results showed that the nurses' care consisted of 83% of person support, 16% of self-support, and less than 1% of self-perspective support. However, the questionnaire responses showed that the nurses regarded all levels of support as equally important. Theoretical frameworks, such as the SAUC model, facilitate descriptions of nursing and may be used to improve the care of suicidal patients by making it deliberate and possible to evaluate.

A first-line nurse manager's goal-profile.

AIM: The aim of this case study was to acquire understanding concerning the first-line nurse manager's goal-profile, i.e. prioritization of goals in her work as a first-line nurse manager, through use of an action-theoretic and confirmatory theory. BACKGROUND: The first-line nurse manager's pivotal role regarding quality of care and development in relation to on-going changes in the health care sector is stressed by many researchers and the transition from nurse to manager is described as a demanding challenge for the first-line nurse manager. METHODS: The case study described in this paper concerns a first-line nurse manager in an actual working environment in care of older people. Data collection comprised interviews, observations, a job description and policy documents. A hermeneutic interpretation was used for data analysis. RESULTS: The results showed that the first-line nurse manager had three goals in her goal-profile, in the following order of priority: (i) a nurse goal that she had strongly accepted and in which she had excellent control, (ii) an administrator goal that she had accepted and in which she had control, (iii) a leadership goal that she had not accepted and in which she did not have control. Both the administrator and leadership goals were based on her job description, but the nurse goal was a personally chosen goal based on her own self-relation/goal-fulfillment. CONCLUSION: The first-line nurse manager's prioritized self-identity, based on successful realization of goals in her goal-profile, was decisive in the manifestation of her work. RELEVANCE TO CLINICAL PRACTICE: This study contributes to a new understanding of the first-line nurse manager's self-identity related to work in terms of goal acceptance and goal control of prioritized goals. This action-theoretic approach could be a valuable 'key' for understanding leadership (or lack of leadership) in clinical practice.

Emotions in relation to healthcare encounters affecting self-esteem.

This study identifies emotions in patients with epilepsy as a result of confirming and disconfirming healthcare experiences. A discussion of emotions as a motive for patients' goal-directed actions was a further aim of this study. The critical incident method was used for data collection. Emotions occurring in confirming and disconfirming healthcare encounters were analyzed using the Belief-Desire Theory of Emotions and were categorized as basic, complex, or self-evaluating. Confirming encounters aroused emotions like hope, a feeling of security, joy, relief, and pride, while disconfirming encounters aroused emotions like despair, fear, unrest, resignation, shame, and guilt. The emotions identified in the healthcare encounters were recognized as motives for action. An emotion such as a feeling of security aroused a desire in the patients to strengthen their positive self and motivated them to have a constructive and sympathetic attitude toward the healthcare experience. An emotion such as anger caused patients to strive to maintain their self-respect either by avoiding difficult situations and ignoring the problem (patients with a low self-esteem) or by trying to re-create a positive self-image (patients with a high self-esteem). Healthcare encounters between patient and caregiver considerably affect the patient's emotional status and thereby his or her well-being. The importance of establishing healthcare encounters that evoke positive emotions that strengthen patients' resources must be addressed in future nursing care.

Confirming mentorship.

BACKGROUND: Mentorship is related to nurses' success in nursing practice linked to professionalism, nursing quality improvement and self-confidence. AIM: To elucidate mentorship of recently registered nurses' view of themselves with regard to their development of nursing competencies by means of the Sympathy-Acceptance-Understanding-Competence (SAUC) model for confirming mentorship. METHODS: Questionnaires, personal interviews and focus group interviews were used for evaluation 2 years after the completion of a year of mentorship, the subjects being eight nurses. FINDINGS: The study showed that novice nurses evaluated their mentors as confirming, which is understood as a key factor for novice nurses' positively reinforced self-relation (perception of themselves) and self-knowledge linked to improved competencies in nursing practice such as more secure and motivated to nurse (S-phase), increased capacity to verbalize nursing situations (A-phase) and to reflect upon and evaluate patient situations based on patients' unique identities as individuals (U-phase), and improved abilities to support patients' own resources as individuals from a more holistic view and to establish collaboration with other professionals. CONCLUSION: Mentorship enabled novice nurses to nurse in a more reflective and holistic way, and their positively reinforced self-relation may be understood as a crucial ingredient for maintaining quality standards in nursing in the future.

Nurses' self-relation--becoming theoretically competent: the SAUC model for confirming nursing.

The purpose of this study was to acquire an understanding of how nurses' self-relation (view of themselves as nurses) was influenced in connection with implementation of a nursing theory, the sympathy-acceptance-understanding-competence model for confirming nursing. This model was developed by Gustafsson and Pörn. Twenty-two nurses' written statements evaluating mentoring during the six-month implementation process in elder care, were analyzed hermeneutically with the hypothetic-deductive method. An action-theoretic and confirmatory approach was used for facilitating theoretically specified hypotheses. The nurses increased their ability to describe nursing theoretically and gained a foundation of common nursing values. The results provided an understanding of how nurses' self-relation was strengthened by becoming theoretically competent.

The influence of confirming and disconfirming healthcare encounters on the self-relation and quality of life of persons with epilepsy.

The nature of epilepsy-related healthcare encounters is important for the self-relation and quality of life of patients with epilepsy. Seventeen positive and 16 negative encounters (critical incident method) were hermeneutically interpreted by an action-theoretic and confirmatory framework. For patients with positive self-assessment (SA), confirming (positive) encounters were intimately related to feelings of partnership and of manageability of their life situation and future. For patients with negative SA, confirming encounters showed that their struggle for human worth had succeeded and their dependence on positive evidence and energy from the healthcare professional was evident. Disconfirming encounters for patients with positive SA were closely linked to experiences of nonchalance and not being taken seriously as resourceful persons, and for patients with negative SA, being objectified as persons without getting any help in their troublesome life situations. The quality of life was especially improved for patients with positive SA by creating and revising life projects, and for patients with negative SA by engaging in social activities. Patients with positive SA and negative SA have different expectations and demands on encounters. This information could be of help in developing programs for encounters based on patients' own evaluation of their self-esteem and their expectations of care and nursing.