Table 2 Categorization of studies in the systematic literature review
Authors | Journal | The main result | Categories of management challenges | Sub-categories of management challenges |
|---|---|---|---|---|
Henriksen E, Rosenqvist U, 2003[18] | Health and Social Care in the Community | The different ways of understanding elderly care services showed a complex and fragmented in organization lacking clear goals, structures and leadership. | Integrated Care Management | Co-operation between organizations |
Henriksen E, Selander G, Rosenqvist U, 2003[19] | Health Policy | All participants agreed on four key visions for the healthcare of the elderly: see the person, see the individual resources, see the encounter and see yourself. Other findings indicated that (a) care of older persons was governed by diverse interests, (b) the organization lacked clear leadership and comprehensive goals, (c) the organization was fragmented and (d) the lack of skilled staff members to meet patient needs. | Integrated Care Management | Co-operation between organizations |
Miller SC, 2010[20] | Journal of Palliative Medicine | Nursing home-hospice collaborators were philosophically and otherwise aligned; they had similar missions, understood their differing approaches to care, and administrators demonstrated an openness and support for the collaboration. | Integrated Care Management | Co-operation between organizations |
Wilson CB, 2009[21] | Health and Social Care in the Community | The key factors influencing relationships that emerged were leadership, continuity of staff, personal philosophy of staff and contribution of residents and families. | Integrated Care Management | Co-operation with informal care |
Madas E, North N, 2000[22] | Australian Health Review | The most prominent issues facing managers were considered to be inadequate funding to match the growing costs of providing long-term care and occupancy levels. | Productivity Management | Financial sustainability |
Rantz MJ, Hicks L, Grando V, et.al. 2004[23] | The Gerontologist | For nursing home to achieve good resident outcomes, they must have leadership that is willing to embrace quality improvement and group process and see that basics of care delivery are done for residents. Good quality care may not cost more than poor quality care. | Productivity Management | Efficiency of care |
Kjos BO, Botten G, Gjevjon ER, Romoren TI, 2010[24] | International Journal for Quality in Health Care | Quality work was fragmented rather than comprehensive and systematic. | Quality Management | Quality assurance system |
Baier R, Butterfield K, Patry G, et.al. 2009[25] | Journal of American Geriatrics Society | Nursing homes with ambitious targets demonstrate greater improvement than their peers selecting less-ambitious targets. | Quality Management | Setting the goals |
Parmelee PA, Bowen, SE, Ross, A, Brown H, Huff J, 2009[26] | Journal of the American Medical Directors Association | Although quantitative ratings were generally positive, qualitative analysis yielded a number of emergent themes regarding data accuracy, team functioning, timeliness of assessments, and validity of MDS tool itself. | Quality Management | Assessment the quality |
Zimmerman S, Gruber-Baldini AL, Hebel JR et.al. 2002[27] | Journal of American Geriatrics Society | High rates of hospitalization for infection were associated with for-profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates. | Quality Management | Leadership and resident outcomes |
Anderson RA, Issel LM, McDaniel RJ, 2003[28] | Nursing Research | Each management practice explained one or more of the resident outcomes. | Quality Management | Leadership and resident outcomes |
Rantz MJ, Grando V, Conn V, et.al. 2003[29] | Journal of Gerontological Nursing | Directors of nursing in facilities with good outcomes are much more likely to have been in their jobs for many years. Facilities with good outcomes are more likely to use group processes for decision-making and most of these facilities have active quality improvement programs. | Quality Management | Leadership and resident outcomes |
Neily J, Howard K, Quigley P, Mills PD, 2005[30] | Joint Commission Journal on Quality and Patient Safety | Leadership support, experience with quality improvement and teamwork skills, and skills gained from the project were correlated with team s’ abilities to achieve and maintain success. | Quality Management | Leadership and resident outcomes |
Scott-Cawiezell J, Main DS, Vojir CP, et.al. 2005[31] | Health Care Management REVIEW | The staff in the high-scoring nursing homes felt valued for their contribution to the provision of high quality care. Contrary to this perspective, leadership from low-scoring nursing homes did not emphasize the value of staff and discussed them as their greatest concern. | Quality Management | Leadership and resident outcomes |
Forbes-Thompson S, Leiker T, Bleich MR, 2007[32] | Health Care Management REVIEW | Leaders in higher-performing homes behaved congruently with the nursing home’s stated and lived mission by fostering connectivity among staff, ample information flow, and the use of cognitive diversity. | Quality Management | Leadership and resident outcomes |
Dellefield ME 2008[33] | Journal of Nursing Care Quality | Supervisors and managers who understood the work of caregiving, respected and valued it, and communicated this to subordinates were likely to be described as providing effective supervision and management. | Quality Management | Leadership and resident outcomes |
Gnaedinger N, 2003[34] | Journal of Social Work in Long-Term Care | Keys to successfully implementing resident-centred approach were identified as: higher staff-to-resident ratios, effective leadership, formal involvement of front line staff in decision making, on-going education and training for all provides, and some rotation of staff scheduling. | Quality Management | Leadership and successful implementation |
Jeong SY-S, Keatinge D 2004[35] | Journal of Nursing Management | The impact of policy change on nursing staff and their practice depended on the management’s leadership in interpreted the new policy and implemented innovative strategies in order to meet its requirements. | Quality Management | Leadership and successful implementation |
Lee RH, Wendling L 2004[36] | American Journal of Medical Quality | High leadership turnover and limited leadership training make it difficult for nursing homes to sustain effective Quality Improvement programs. | Quality Management | Leadership and successful implementation |
Morgan DG, Stewart NJ, D'Arcy C, Cammer AL 2005[37] | Canadian Journal of Nursing Leadership | The key finding was the critical role of nursing leadership and supervision in creating and sustaining the unit. Four key leadership activities were identified: perpetual reinforcement, enforcement of SCU goals and ideals; support, guidance and mentoring of staff; empowerment of staff; and liaison/public relations. | Quality Management | Leadership and successful implementation |
Scott-Cawiezell J, Vogelsmeier A, McKenney C, et.al. 2006[38] | Nursing Forum | Nurse leaders can create an environment in which every member of the team feels a responsibility and an ability to ensure that residents are safe by improving communication and participation in decision making. | Quality Management | Leadership and successful implementation |
Bostrom A-M, Wallin L, Nordstrom G, 2007[39] | Journal of Evaluation in Clinical Practice | Four factors were significantly related to research utilization, namely: attitudes toward research, seeking research that is related to clinical practice, support from unit manager and access to research findings at work place. | Quality Management | Leadership and successful implementation |
Ploeg J, Davies B, Edwards N, et.al. 2007[40] | Worldviews of Evidence-Based Nursing | Staff, CRNs and administrators identified support from nurse managers and administrators at all levels of the organization as a key facilitator for successful guideline implementation. | Quality Management | Leadership and successful implementation |
Cruttenden KE, 2006[41] | Canadian Journal on Aging | Leadership strengths defined the roles for categories of staff and supported the capacity of each category to identify their learning needs. | Workforce Management | Training |
Morgan JC, Konrad TR, 2008[42] | The Gerontologist | Managers’, supervisors’, and participating NA’s consistent perceptions of improved quality of care and job quality, along with a promise of increased retention, suggest that interventions like WIN A STEP UP are beneficial. | Workforce Management | Training |
Häggström E, Bruhn Å, 2009[43] | Nurse Education Today | The management did not create conditions that made it possible to participate during working hours [education ]. | Workforce Management | Training |
Mitchell CM, Zimmerman S, Beeber AS, 2010[44] | Alzheimer’s Care Today | The odds of attending the training increased with staff age, and the odds were higher for staff reporting more effective leadership and who worked in facilities that were more tolerant of residents who displayed behavioral symptoms. | Workforce Management | Training |
Anderson RA, Corazzini KN , McDaniel RR, 2004[45] | The Gerontologist | In nursing home with reward-based administrative climates, higher levels of communication openness and accuracy explained lower turnover of licensed vocational nurses and certified nurse assistants relative to nursing homes with an ambiguous climate. | Workforce Management | Staff stability |
Hsieh P, Su H, 2007[46] | International Journal of Nursing Studies | Major reason for staying were personal interest in caring elderly, good financial benefits from the facility and supportive leadership. | Workforce Management | Staff stability |
Kemper P, Brannon D, Barry T, Stott A, Heier B 2008[47] | The Gerontologist | Factors that affected project implementation included having demonstration resources; strong, stable leadership; strong coalition that included key stakeholders; neutral lead agency; clear goals; effective process; and a favorable state history and context. | Workforce Management | Staff accessibility |
Donoghue C, Castle NG, 2009[48] | The Gerontologist | NHAs who are consensus managers (leaders who are solicit, and act upon, the most input from their staff) are associated with the lowest turnover levels, 7% for RNs, 3% for LPNs, and 44% for NAs. | Workforce Management | Staff stability |
Tourangeau A, Cranley L, Spence Laschinger HK, Pachis J 2010[49] | Journal of Nursing Management | No relationship was found between leadership practices and job satisfaction or turnover intention. | Workforce Management | Staff stability |
Wilson AA, 2005[50] | Nursing Administration Quarterly | The management education program significantly increased their intent to stay in their current positions. | Workforce Management | Managers stability |
Forbes-Thompson S, Gajewski B, Scott-Cawiezell J, Dunton N 2006[51] | Western Journal of Nursing Research | Turnover of the NHA and DON is significantly and negatively associated with communication and teamwork. | Workforce Management | Managers stability |
Holecek T, Dellmann-Jenkins M, Curry D, 2010[52] | Journal of Applied Gerontology | An overall positive perception of the survey process was a significant predictor of administrator job satisfaction and job seeking. | Workforce Management | Managers stability |
Kash BA, Naufal GS, Dagher RK, Johnson CE, 2010[53] | Health Care Management REVIEW | Higher perceived salary competitiveness and level of empowerment were associated with reduced odds of intending to leave. Higher educational levels were associated with higher odds of intentions to leave. | Workforce Management | Managers stability |
Siegel EO, Young HM, Mitchell PH, Shannon SE, 2008[54] | The Gerontologist | Findings revealed (a) considerable variation in organizational resources, systems, and processes to support organization and operationalization of the supervisory role; and (b) limited evidence of nurses’ estimation of the potential benefits of training and organizational systems to support supervisory practice and the complexity of the supervisory role. | Workforce Management | Division of labor |
Corazzini KN, Anderson RA, Rapp CG, et.al. 2010[55] | Online Journal of Issues in Nursing | All of nurses who participated in the interviews could articulate benefits of delegation. Delegation was seen as solution to the fact that RN in leadership role could not do everything…delegated had a sense of empowerment by staff. | Workforce Management | Division of labor |
Kjos BO, Botten G, Romoren TI, 2008[56] | International Journal for Quality in Health Care | The technical component that requires training in tools and techniques was low. Results show …greater progress in implementing the general quality improvements components than they did in implementing the technical quality improvement components that require training in tools and techniques. | ICT Management | ICT management tool |
Authors | Journal | The main result | Data-Based Categories | |
Aroian JF, Patsdaugther CA, Wyszynski ME, 2000[57] | Nursing Economics | DONs in LTCNF reported that they were most involved in roles/responsibilities related to nursing/heath services management and least involved in professional nursing and long-term care management | Leader’s own opinion of her/his skills, role, style | |
Scott-Cawiezell J, Jones K, Moore L, 2005[58] | Journal of Nursing Care Quality | Leaders were more often reported to reflect hierarchy value orientation, emphasizing efficiency of operations and following rules and procedures. | Leader’s own opinion of her/his skills, role, style | |
Johansson G, Pörn I, Theorell T, Gustafsson B, 2007[59] | Journal of Clinical Nursing | The first-line 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. | Leader’s own opinion of her/his skills, role, style | |
Shanley C, 2007[60] | Journal of Organizational Change Management | The management of change is in the background of management thinking and practice in the industry [residential aged care]. | Leader’s own opinion of her/his skills, role, style | |
McGilton KS, Bowers B, McKenzie-Green B, et.al. 2009[61] | Journal of Applied Gerontology | Themes that captures the following dimensions of the supervisory role in LTC include a) against all odds, getting through the day; (b) stepping in work; and c) leading and supporting unregulated care workers. | Leader’s own opinion of her/his skills, role, style | |
Vesterinen S, Isola A, Paasivaara L, 2009[62] | Journal of Nursing Management | Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. | Leader’s own opinion of her/his skills, role, style | |
Nielsen K, Cleal B, 2010[63] | Journal of Occupational Health Psychology | Line managers in elderly care experienced flow more often than accountancy line managers, and activities such as planning, problem solving, and evaluation predicted transient flow states. | Leader’s own opinion of her/his skills, role, style | |
Abdelrazek F, Skytt B, Aly M, 2010[64] | Journal of Nursing Management | FLMs’ perceptions of their leadership and management skills and psychological empowerment were quite high, whereas scores for job satisfaction and psychosomatic health were lower. FLMs had higher values in several factors variables in Egypt compared with in Sweden. | Leader’s own opinion of her/his skills, role, style | |
Albinsson L, Strang P, 2002[65] | Health and Social Care in the Community | The nearly unanimous opinions of the interviewees indicated that there was a great lack of daily leadership in the units. | Supportive and transformational leadership | |
Scott-Cawiezell J, Schenkman M, Moore L, 2004[66] | Journal of Nursing Care Quality | In terms of leadership, licensed practical nurses perceived less clarity of expectations, encouragement of initiative, and support than other groups. | Supportive and transformational leadership | |
Hall L, McGilton KS, Krejci J, et.al. 2005[67] | Journal of Nursing Administration | Many of behaviors identified as supportive by staff and supervisors in long-term care settings in this study can be linked to transformational leadership. | Supportive and transformational leadership | |
McGilton KS, McGillis Hall L, Boscart V, Brown M, 2007[68] | Canadian Journal of Nursing Leadeship | Forty-five percent of the total variance in job satisfaction of nurse supervisors was explained by supervisory support, stress and job category (registered nurse vs. registered practical nurse). Greater supervisory support was also associated with reduced job stress. | Supportive and transformational leadership | |
Nielsen K, Randall R, Yarker J, Brenner S-O, 2008[69] | Work & Stress | The results indicated that followers’ perceptions of their work characteristics did mediate the relationship between transformational leadership style and psychological well-being. | Supportive and transformational leadership | |
Heponiemi T, Elovainio M, Pekkarinen L, Sinervo T, 2008[70] | Journal of Community Psychology | Fair treatment and management protected against work interference with family when demands were low but were unable to buffer against the negative effects of high job demands. | Supportive and transformational leadership | |
Al-Hussami M, 2009[71] | Australian Journal of Advanced Nursing | Job satisfaction and perceived organizational support were most strongly related to nurses’ commitment to their organizations. | Supportive and transformational leadership | |
Nielsen K, Munir F, 2009[72] | Work & Stress | Followers’ self-ratings of self-efficacy mediated the relationship between transformational leadership style and positive affective well-being. Only limited evidence for a direct path between leadership behavior and positive affective well-being was found. | Supportive and transformational leadership | |
Nielsen K, Yarker J, Randall R, Munir F, 2009[73] | International Journal of Nursing Studies | Self-efficacy was found to fully mediate the relationship between transformational leadership and well-being and team efficacy was found to partially mediate the relationship between transformational leadership and job satisfaction and fully mediate the relationship between transformational leadership and well-being. | Supportive and transformational leadership | |
Testad I, Mikkelsen A, Ballard C, Aarsland D, 2009[74] | International Journal of Geriatric Psychiatry | QPS Nordic subscales significantly associated with stress in care staff were those associated with leadership. | Supportive and transformational leadership | |
Winslow JH, Nielsen K, Borg V, 2009[75] | Journal of Advanced Nursing | The more supervisors felt supported by fellow supervisors, the more their subordinates felt support by them. | Supportive and transformational leadership | |