The challenges of change processes for nurse leaders-a qualitative study of long-term leaders' experiences over 25 years.

AIM: This study aimed to map what experiences nurse leaders have encountered concerning the change work that political decisions and reforms have created within the healthcare sector in the last 25 years. DESIGN: A qualitative design with a narrative approach was used. METHODS: A qualitative study involved individual interviews of eight nurse managers from Norway and Finland with more than 25 years of experience working in specialist and primary healthcare fields. RESULTS: Two main categories were observed: experiences of organizational challenges and experiences of personnel-administrative challenges. The first main category included two subcategories: A: historical experience with culture and challenges in health services and B: historical experience with mergers and using welfare technology in health services. The second category included the following subcategories: A: historical experience of job satisfaction for leaders and employees and B experiences with interprofessional collaboration in health services.

Leader-member exchanges with leaders who have worked for 25 years in health institutions.

AIM: The aim is to investigate long-term leader experiences with leader- member exchanges (LMX) over 25 years. Leader-member exchanges focus on relational power and communication exchanges between leaders and employees when they communicate with each other or perform an action. DESIGN: This qualitative study is characterized by a phenomenological hermeneutical design and is based on the informants' interpretation and construction of meaning. METHOD: A qualitative study with eight interviews with supreme nurse leaders from the Norwegian and Finnish health care services. RESULT: The data analysis and interpretation show that relationships are built through trust, dialogue and confirmation and are affected by other contextual aspects such as the organizational size or workload and human factors such as safety, angst, and self-esteem. The informants fight for their subordinates. Interprofessional management and obtaining good relations with the doctors was challenging. No Patient or Public Contribution.

Exploring sustainable care pathways - a scoping review.

BACKGROUND: Patients with mental health problems experience numerous transitions into and out of hospital. AIM: The review studies assessing clinical care pathways between psychiatric hospitalization and community health services. METHODS: We used publications between 2009-2020 to allow a broad scoping review of the published research. Sixteen review-articles were identified, 12 primary studies were chosen, both on care pathways in the transition between psychiatric hospital and community. RESULTS: Organizational issues: Systems and procedures to ensure clear responsibilities and transparency at each stage of the pathways of care. RESOURCES: Information-technology in objectively improving patient outcome. Information/documentation: Providing patients with adequate structured information and documented plans at the appropriate time. Patient/families: Continuous collaborative decision-making. Clinical care and teamwork: Collaboration between mental health and other professionals to guarantee that planned activities meet patient need. ETHICAL ISSUES: Respectful communication and patient-centred, non-humiliating care. CONCLUSIONS: System and procedures ensure clear responsibilities and transparency. Information technology support decision-making and referral and objectively improve patient outcomes in care pathways. Collaboration between mental health and other professionals guarantee that planned activities meet patients' needs along with regular meetings sharing key information. Around-the-clock ambulant-teams important to transition success. Informed-shared decision-making between parties, support patient participation and respectful communication.

Nurse leaders' changing roles over 25 years: a qualitative study.

PURPOSE: The purpose of this study is to emphasise nurses' experiences of nurse leaders' changing roles over 25 years. DESIGN/METHODOLOGY/APPROACH: A qualitative study was performed with individual interviews of eight nurse managers. From Norway and Finland, all nurse managers with more than 25 years of experience and working in specialist health care and primary health care were included in the study. FINDINGS: These nurse managers have a lot of knowledge and resolved conflicts using improved methods and have experienced continuous change. The role of nurse manager ranges from bedside to exclusive administrative work. The organisations have become more extensive, and the staff has grown. These changes have led to many challenges and more complex organisations. RESEARCH LIMITATIONS/IMPLICATIONS: Nurse managers who have worked for over a 25-year period had useful experience and could handle many new challenges. They can change themselves and their organisation tasks over time and follow the development of society. ORIGINALITY/VALUE: Based on their experiences as novices at the beginning of their career, the informants demonstrate their development to the level of expert manager.

A qualitative study of supervisors' experiences with nursing students in practice, a new guidance model.

INTRODUCTION: Clinical practice stimulates students to use their critical thinking skills for problem solving. Collaboration between educational institutions and practices can also be challenging. AIM: This study aimed to determine supervisors' experiences using a case model in clinical supervision and evaluation. METHOD: After a period in which a new case model was implemented in clinical practice for nursing students, their supervisors were interviewed. A total of six informants participated, and their ages ranged from 25 to 35 years old. RESULTS: The case model was a new and better way to make the connections between theory and practice. The supervisors were not ready to take over any more central or final evaluation responsibility. DISCUSSION/CONCLUSION: We discuss whether supervisors can take responsibility for some of this evaluation work, especially at the end of the practice period. This study shows that the need is there, but many experienced supervisors prefer to adopt the standards that were in use when they were completing their studies.

Patients' perspectives on care pathways and informed shared decision making in the transition between psychiatric hospitalization and the community.

RATIONALE, AIMS, AND OBJECTIVES: Patients with mental health problems experience numerous transitions into and out of hospital. This study explores former patients' views of pathways in transition between district psychiatric hospital centres (DPCs) and community mental health services. METHOD: A descriptive qualitative design was chosen. Three focus group interviews with a total of 10 informants from five different communities were conducted. Interviews were transcribed and analysed thematically where themes describe promoting or inhibitory factors to the transition phase. RESULTS: The informants shared their experiences on issues promoting and preventing successful care pathways in mental health. Four main paired themes were identified: (a) patient participation/activation/empowerment versus paternalism and institutionalization, (b) patient-centred care versus care interpreted as humiliation, (c) interprofessional collaboration or teamwork versus unsafe patient pathways in mental health services, and (d) sustainable integrated care versus fragmented, noncollaborative care. CONCLUSIONS: Shared decision making was reported more precisely as informed shared decision making. Shared information between all parties involved in care pathways is key.

University teachers' views of interprofessional learning and their role in achieving outcomes - a qualitative study.

Over the past decade, there has been a rapid increase in higher education institutions offering opportunities for interprofessional learning (IPL) to their students. The literature presents a number of factors that contribute to effective IPL, including having trained facilitators that help optimise the learning process. Many of these IPL facilitators are university teachers and the literature provides us with some insight into their views of IPL. However, little is known about university teachers' views about IPL and their role in supporting students in achieving outcomes linked to IPL during their own teaching; this paper explores these areas. University teachers, working with students in Norway and England who contribute to patients' care pathway were purposively invited to join focus groups. Data collected from the teachers' conversations during these focus groups were analysed to elicit the main themes. Findings show that university teachers have a wide range of views about IPL, its potential to enhance collaborative practice and care, and their role in helping students achieve outcomes linked to IPL. A key challenge appears to be whether IPL is "worth the struggle," which emphasises the need for strong leadership in order to align pedagogical approaches in education and practice that strive to achieve agreed outcomes.

The effects of performance appraisal in the Norwegian municipal health services: a case study.

INTRODUCTION: Previous research in performance appraisal (PA) indicates that variation exists in learning and job motivation from performance appraisal between occupational groups. This research evaluates the potential effect of job motivation, learning and self-assessment through performance appraisals for health personnel. CASE DESCRIPTION: This article focuses on goal-setting, feedback, participation and training in performance appraisals in municipal health services in Norway; and job motivation, learning and self-assessment of performance are the dependent factors. Questionnaires were distributed to a representative sample of 600 health personnel from the Norwegian municipal health service, with a response rate of 62%. Factor analysis and regression analysis were run in SPSS 12. DISCUSSION AND EVALUATION: The study suggests that respondents learn from performance appraisal. Nurses experienced some higher job motivation from performance appraisal than auxiliary nurses. All subordinates perceived higher job motivation after performance appraisal than managers. CONCLUSION: Useful feedback, active participation and higher education are fundamental elements of discussion in performance appraisal, as well as the role of increasing employees' job motivation. In this study, nurses' job motivation seems to be more effected by PA, than for auxiliary nurses. Both nurses and auxiliary nurses indicate that there is a learning effect from PA. This study may be of interest to health researchers and managers in municipal health services.

Employees' perceptions of justice in performance appraisals.

Of all the tasks undertaken by human resource managers, performance appraisals (PAs) are one of the most unpopular among employees (Meyer 1991, Murphy and Cleveland 1995, Holbrook 2002, Jackman and Strober 2003). As PA guides and plans show (Fletcher 2004, CatalystOne 2010), PAs can be implemented in similar ways in organisations throughout Europe and developed countries elsewhere. But, if employees perceive PA processes as unfair, they may reject the usefulness and validity of the information they receive and so may not be motivated to change behaviour. This article concerns perceptions of organisational justice and explains the results of a study of perceived fairness in PAs among nurses and auxiliary nurses in Norway's municipal health service.