Factors associated with dementia care practices among community health nurses: Results of a postal survey

Background

The incremental prevalence of dementia is making dementia management a worldwide issue. The role of community health nurses must grow along with the increasing aging population and the resulting increase in dementia cases.

Objectives

Explore the factors related to dementia care practices among the different types of community health nurses in Taiwan.

Design

Cross-sectional study.

Setting

Primary care centers or institutions in New Taipei City.

Participants

Community health nurses who work in health care centers (district nurses), long-term care centers (care managers), or home care institutions (home health care nurses).

Methods

Self-completion questionnaires sent by mail.

Results

A total of 195 participants returned the questionnaires (response rate 81.9%). Although 65.8% of participants had experience in case finding, just 34.6% of them reported using validated cognitive testing tools. Only 15% of participants provided case management following dementia case findings. The regression models showed that the different types of community health nurses, number of years working as a nurse, and their level of confidence was significantly related to their dementia care practice. District nurses identified significantly less suspected dementia cases and provided less nursing care to caregivers of dementia patients than care managers and home health care nurses. Among community health nurses, the care managers most often used formal cognitive instruments. District nurses provided the least amount of supportive resources information, had the most negative attitude and the lowest level of confidence toward dementia care than care managers and home health care nurses.

Conclusions

This study presented the profiles of dementia care practice in Taiwan. It showed the considerable variation in knowledge, attitude, confidence and dementia care practices among the different community health nurses. The professional roles regarding dementia care in Taiwan remain blurred. Future training must focus on promoting the level of confidence of community health nurses to identify and manage people with dementia and raise awareness about demented person's and their caregiver's need. The priority of the policy on dementia care in the community must be raised to high, and the professional responsibilities and roles of the different types of community health nurses for the ever increasing dementia population in Taiwan must be redefined and optimized.     

Emergency Physicians' and Nurses' Attitudes towards Alcohol-Intoxicated Patients

Background

Emergency physicians and nurses are frequently dissatisfied professionally when treating alcohol-intoxicated patients, and have negative attitudes towards this patient population and alcohol rehabilitation.

Study Objectives

The goal of this study is to examine differences in attitudes between emergency physicians and nurses towards alcohol-intoxicated patients.

Methods

This single-site survey study evaluated emergency physicians' and nurses': 1) attitudes of personal professional satisfaction and dissatisfaction when caring for intoxicated patients; 2) attitudes towards the difficulty in caring for alcohol-intoxicated patients; 3) attitudes towards respect of the alcohol-intoxicated patient; 4) attitudes towards the adequacy of training in caring for intoxicated patients; 5) attitudes towards rehabilitation and counseling of alcohol-intoxicated patients.

Results

Physicians were less satisfied and more dissatisfied than nurses when caring for alcohol-intoxicated patients. Physicians found treating alcohol-intoxicated patients more difficult than nurses did. Physicians were more likely to agree that alcohol-intoxicated patients should be treated with respect. Physicians felt more adequately trained than nurses in caring for alcohol-intoxicated patients. Nurses were more likely to believe that alcohol-related rehabilitation is ineffective compared with physicians. Both nurses and physicians refer alcohol-intoxicated patients to rehabilitation to a similar extent.

Conclusions

Emergency physicians and nurses have similar attitudes but significant differences in the extent of these attitudes towards the care of the alcohol-intoxicated patient.     

District nurses' attitudes toward patient consent: the case of mechanical ventilation on amyotrophic lateral sclerosis patients: results from a French national survey

Purpose

In France, a recent law emphasizes patient rights and prohibits unwanted therapies in end-of-life care. As end-of-life home care is increasing, we aimed to assess French district nurses' attitudes toward terminally ill patients' autonomy.

Materials and Methods

We used data from a nationwide telephone survey conducted in 2005 among a random sample of French district nurses (n = 602). Nurses' attitudes were assessed with a clinical case describing a patient (randomly defined as a male or a female aged 50 years) having amyotrophic lateral sclerosis (ALS) who urgently needs mechanical ventilation. Nurses were asked whether patient consent was necessary before performing intubation/tracheotomy, and the analysis took into account various covariates, including nurses' religiosity, nurses' attitudes toward living wills, and patient sex.

Results

Overall, 44% of nurses considered that an ALS patient with respiratory failure should always be intubated (53% for a female patient, 40% for a male patient, P < .01), and after intubation, 27% upheld tracheotomy without considering patient consent as a necessary prerequisite (39% among male nurses, 30% among female nurses, P < .05). Poor communication with terminal patients and hostility toward living will were also predictive of willingness to perform both mechanical ventilation and tracheotomy without patient consent.

Conclusions

A significant part of French district nurses may have a disturbing propensity to support intubation and tracheotomy with insufficient attention paid to the patient's will. Further research should investigate potential causal factors (such as increased workload) as well as sex-related attitudes in nurse-patient relationship.     

A nursing historical perspective on the medical home: Impact on health care policy

Background

The idea of a “medical home” is rapidly gaining in popularity in health policy circles today. In the face of a shortage of primary care physicians, it has led to a national debate about who should lead the homes, who should deliver care, the kind of care that should be offered, and the location of that care. A historical examination of nurses' role in primary care can provide evidence to inform the current dialogue.

Purpose

This article provides insight into nursing's role in primary health care during the early 20th century.

Methods

Traditional historical methods were used.

Discussion/Conclusions

Three historical case studies provide evidence of how nursing and medicine worked together in the past and informs the discussion about using nurses to deliver primary health care today. Policy makers should not overlook the central role nurses have long played in providing access to care for numerous underserved populations. Makers should not overlook the central role nurses have long played in providing access to care for numerous underserved populations.     

Limiting life-sustaining treatment in German intensive care units: A multiprofessional survey

Purpose

Deciding about the limitation of life-sustaining treatment (LST) is a major challenge for intensive care medicine. The aim of the study was to investigate the practices and perspectives of German intensive care nurses and physicians on limiting LST.

Methods

We conducted an anonymous, self-administered questionnaire survey among the 268 nurses and 95 physicians on all 10 intensive care units of the Munich University Hospital, Germany.

Results

The response rate was 53%. Of all respondents, 91% reported being confronted with the topic at least once a month. Although all reported limiting cardiopulmonary resuscitation, almost no one reported limiting artificial hydration. Half of nurses and junior physicians felt uncertain about the decision-making process. Junior physicians were most dissatisfied with their training for this task and expressed the highest fear of litigation. Nurses were less satisfied than physicians with the communication process. Both nurses and relatives were not routinely involved in decision making. There is no standardized documentation practice, and many notes are not readily accessible to nurses.

Conclusions

Limiting LST is common in German intensive care units. The major shortcomings are team communication, communication with the patient's family, and documentation of the decision-making process.     

Nursing unit teams matter: Impact of unit-level nurse practice environment,nurse work characteristics,and burnout on nurse reported job outcomes,and quality of care,and patient adverse events—A cross-sectional survey

Aim

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level.

Background

Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment.

Design

A cross-sectional design with a survey.

Method

In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques.

Results

Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors.

Conclusion

Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development.     

The feasibility of volunteers facilitating personalized activities for nursing home residents with dementia and agitation

Background

Nursing home residents' behavioral and psychological symptoms of dementia are often exacerbated by a lack of social contact and meaningful activity. Volunteers might assist in addressing this deficiency but they are often discouraged by staff from engaging with residents with challenging behaviors. As a result, some of the neediest residents receive the least social and psychological support.

Aim

This project explored the implementation of personalized, one-to-one activities by nursing home volunteers to determine if volunteers were able and willing to complete a training program and undertake activities with residents with dementia and challenging behaviors.

Methods

19 nursing home volunteers in Melbourne, Australia, were trained to apply Montessori-type personalized activities with a selected resident whose dementia was complicated by a frequent, non-aggressive agitated behavior. The volunteers were asked to attend a workshop and pay six 30-min visits to the resident over a three week period. They completed knowledge and attitude rating scales before and after the intervention and were interviewed afterward regarding their experiences and perceptions.

Results

16 volunteers completed the program and eight met or exceeded every study requirement. Most of them derived satisfaction from engaging residents' interest and were pleased to learn new skills. The scores on the dementia knowledge and attitude rating scale of those who completed the visits were higher at the study's outset than the scores of those who failed to make any visits.

Conclusions

It is certainly feasible to train volunteers to work with residents who might otherwise be isolated. It is important to demonstrate activities to volunteers at the outset and to provide them with careful, ongoing supervision and support. Notwithstanding some difficulties and challenges, volunteers represent a growing and hitherto untapped pool of support for people with dementia and complex needs.     

Residents' and nurses' perceptions of team function in the medical intensive care unit

Background

Team-based care is integral to modern intensive care units (ICUs). Trainee physicians (“residents”) serve as core team members who provide direct patient care in academic ICUs. However, little is known about how resident perceptions of ICU team function differ from those of other disciplines. Therefore, we compared residents' perceptions to those of nurses', the other predominant direct caregiver group, in the medical ICU.

Methods

A cross-sectional survey was performed with validated team function scales including presence of a real team, communication quality, collaboration, and coordination. The survey was administered to nurses and residents in medical ICUs in an urban academic medical center. We analyzed differences between nurses and residents both in their responses and in their perceptions of how constructs were interrelated.

Results

Residents felt that the team was more bounded, was more collaborative, and planned its work to a greater degree, but they were less satisfied with communication, compared with nurses. Residents and nurses perceived relationships between team function constructs in very similar ways. Both groups felt that communication openness and collaboration were positively associated but that communication accuracy and timeliness were negatively correlated, revealing an opportunity to improve overall team performance.

Conclusions

We found important differences in the way that ICU nurses and medical trainee physicians, the predominant types of providers caring for the critically ill in academic medical center ICUs, perceive key aspects of team function. These results may be useful to those responsible for administering academic ICUs as well as to residency program directors developing communication- and team-based curricula.     

The relationship between nurse practice environment,nurse work characteristics,burnout and job outcome and quality of nursing care: A cross-sectional survey

Aim

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment.

Background

Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community.

Design

Cross-sectional survey.

Method

Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N = 1201) in two independent hospitals and one hospital group with six hospitals in Belgium.

Results

Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses’ work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively.

Conclusion

The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses’ involvement in decision-making process and interdisciplinary teamwork are recommended.     

Communication gaps in nursing home transfers to the ED: impact on turnaround time,disposition, and diagnostic testing

Introduction

This study aims to determine the source of communication gaps in history of present illness (HPI), medical history, and advanced directives in nursing home (NH) patients transferred to the emergency department (ED). We also attempt to determine if these gaps create differences in patient turnaround time (TAT), disposition decision, or diagnostic testing.

Methods

A convenience sample of patients transferred from NHs to a level 1 community trauma center was enrolled by the physicians caring for them. The physicians assessed the adequacy and source of the history for each patient. The patient's chart was then retrospectively reviewed to determine disposition, ED TAT, and diagnostic tests ordered.

Results

One hundred patients were enrolled. Physicians found that NH paperwork contained adequate HPI 35% of the time. Patients could provide their own HPI 28% of the time. In 32% of patients, adequate HPI could not be obtained from the patient, NH paperwork, or NH personnel. Comparing patients in whom adequate HPI was available (n = 68) to those in whom HPI was not available (n = 32), there was no difference in TAT (146 vs 173 minutes, P = .22), admissions (60% vs 66%, P = .66), or diagnostic testing (P = .89-1.0).

Conclusion

Emergency department physicians often do not have adequate HPI in patients transferred from NHs. The absence of adequate information does not affect patient TAT, disposition decision, or ED diagnostic testing.     

A prospective study of nurses’ intentions to leave the profession during their first five years of practice in Sweden

Background

Nursing turnover continues to be a problem for healthcare organizations. Longitudinal research is needed in order to monitor the development of turnover intentions to leave the profession over time.

Objective

The objectives were: (1) to investigate the prevalence of new graduates’ intentions to leave the nursing profession, (2) to prospectively monitor the development of intention to leave during the first five years of professional life, and (3) to study the impact of sex, age, occupational preparedness and burnout (i.e. exhaustion and disengagement) on the development of intention to leave the profession.

Design

Longitudinal observational study.

Participants

Participants were recruited from first-year nursing students at any of the 26 universities in Sweden offering nursing education. Of the 2331 student nurses who were invited to participate in the study, 1702 (73%) gave informed consent and thus constituted the cohort. This cohort was prospectively followed yearly (three times during education and five times post graduation) from late autumn 2002 to spring 2010. Of the 1501 respondents who continued to participate after graduating, 1417 worked as nurses at the time of data collection and responded to the items regarding intention to leave the nursing profession during at least one wave of measurement; these constituted the sample of the present longitudinal study.

Methods

The outcome variable was intention to leave the nursing profession. This was measured using a scale of three items, covering thoughts of leaving the profession. The main predictor was burnout, and this was measured by the exhaustion and disengagement scale from the Oldenburg Burnout Inventory. Data were analysed using latent growth curve modelling.

Results

After five years, every fifth nurse strongly intended to leave the profession. The longitudinal analysis of change in intention to leave showed that levels increased during the first years of employment. High levels of burnout were related to an increase in intention to leave.

Conclusion

It is important for organizations employing new graduates to pay attention to nurses who show early signs of burnout, and provide a resourceful work environment with a suitable workload, sufficient introduction, management support, satisfactory collaboration with colleagues, and role clarity.     

The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study

Context

End-of-life care in nursing homes (NHs) needs improvement. We carried out a study in 29 NHs in the Lombardy Region (Italy).

Ward nurses' experiences of the discharge process between intensive care unit and general ward

Background

Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step‐down unit.

Aims and objectives

The aim of this study was to explore general ward nurses' experiences of caring for patients being discharged from an ICU.

Design and methods

Data were collected from focus groups and in‐depth interviews with a total of 16 nurses from three different hospitals in Sweden. An inductive qualitative design was chosen.

Findings

The analysis revealed three themes that reflect the challenges in nursing former ICU patients: a vulnerable patient, nurses' powerlessness and organizational structure. The nurses described the challenge of nursing a fragile patient based on several aspects. They expressed feeling unrealistic demands when caring for a fragile former ICU patient. The demands were related to their own profession and knowledge regarding how to care for this group of patients. The organizational structure had an impact on how the nurses' caring practice could be realized. This evoked ethical concerns that the nurses had to cope with as the organization's care guidelines did not always favour the patients.

Conclusions

The structure of the organization and its leadership appear to have a significant impact on the nurses' ability to offer patients the care they need.

Relevance to clinical practice

This study sheds light on the need for extended outreach services and intermediate care in order to meet the needs of patients after the intensive care period.

     

Waiting and watching: Nurse migration trends before a change to the National Council Licensure Examination as entry to practice for Canada's nurses

Background

A number of factors in the health care environment, including a change in regulatory policy, may affect a country's nursing workforce and nurse migration and mobility.

Purpose

This study compared the characteristics of Canadian-educated nurses who had migrated to the United States to work with their colleagues in the United States and Canada in anticipation of a change in Canada's RN entry to practice requirements in 2015.

Methods

We conducted a retrospective comparative study of nurses in Canada and the U.S. using 2008 data from the US National Sample Survey of Registered Nurses and the Canadian Institute of Health Information.

Discussion

There was little change in the number of Canadian-educated nurses working in the United States in 2008 compared with 2004. We found differences between U.S. nurses and Canadian-educated nurses working in the United States in educational level, work status, work location, and age. No differences were found between Canadian-educated nurses working in the United States and those working in Canada.

Conclusions

This research highlights the value of international comparisons of the nursing workforce, especially in the context of anticipated regulatory changes, which may affect a country's nursing health human resources.     

The challenges of achieving person-centred care in acute hospitals: A qualitative study of people with dementia and their families

Background

Person-centred care has been identified as the ideal approach to caring for people with dementia. Developed in relation to long stay settings, there are challenges to its implementation in acute settings. However, international policy indicates that acute care for people with dementia should be informed by the principles of person-centred care and interventions should be designed to sustain their personhood.

Objectives

Using Kitwood's five dimensions of personhood as an a priori framework, the aim of this paper was to explore the way in which current approaches to care in acute settings had the potential to enhance personhood in older adults with dementia.

Design

Data collected to explore the current experiences of people with dementia, family carers and co-patients (patients sharing the ward with people with mental health problems) during hospitalisation for acute illness were analysed using a dementia framework that described core elements of person centred care for people with dementia.

Settings

Recruitment was from two major hospitals within the East Midlands region of the UK, focusing on patients who were admitted to general medical, health care for older people, and orthopaedic wards.

Participants

Participants were people aged over 70 on the identified acute wards, identified through a screeing process as having possible mental health problems. 34 patients and their relatives were recruited: this analysis focused on the 29 patients with cognitive impairment.

Method

The study involved 72 h of ward-based non-participant observations of care complemented by 30 formal interviews after discharge concerning the experiences of the 29 patients with cognitive impairment. Analysis used the five domains of Kitwood's model of personhood as an a priori framework: identity, inclusion, attachment, comfort and occupation.

Results

While there were examples of good practice, health care professionals in acute settings were not grasping all opportunities to sustain personhood for people with dementia.

Conclusions

There is a need for the concept of person-centred care to be valued at the level of both the individual and the organisation/team for people with dementia to have appropriate care in acute settings.     

Burnout intervention studies for inpatient elderly care nursing staff: Systematic literature review

Background

Staff providing inpatient elderly and geriatric long-term care are exposed to a large number of factors that can lead to the development of burnout syndrome. Burnout is associated with an increased risk of absence from work, low work satisfaction, and an increased intention to leave. Due to the fact that the number of geriatric nursing staff is already insufficient, research on interventions aimed at reducing work-related stress in inpatient elderly care is needed.

Objective

The aim of this systematic review was to identify and analyse burnout intervention studies among nursing staff in the inpatient elderly and geriatric long-term care sector.

Methods

A systematic search of burnout intervention studies was conducted in the databases Embase, Medline and PsycNet published from 2000 to January 2012.

Results

We identified 16 intervention studies. Interventions were grouped into work-directed (n = 2), person-directed (n = 9) and combined approaches (work- and person-directed, n = 5). Seven out of 16 studies observed a reduction in staff burnout. Among them are two studies with a work-directed, two with a person-directed and three with a combined approach. Person-directed interventions reduced burnout in the short term (up to 1 month), while work-directed interventions and those with a combined approach were able to reduce burnout over a longer term (from 1 month to more than 1 year). In addition to staff burnout, three studies observed positive effects relating to the client outcomes. Only three out of ten Randomised Control Trials (RCT) found that interventions had a positive effect on staff burnout.

Conclusion

Work-directed and combined interventions are able to achieve beneficial longer-term effects on staff burnout. Person-directed interventions achieve short-term results in reducing staff burnout. However, the evidence is limited.     

Resident outcomes of person-centered care in long-term care: A narrative review of interventional research

Background

Person-centered care has been widely promoted in long-term care settings. It is commonly referred to as a core concept that guides the care philosophy change in long-term care settings from a traditional medical model to a more humanistic approach to care. Current person-centered practice in long-term care settings is guided by multiple person-centered care models. However, evidence regarding the effects of person-centered practice guided by multiple models on residents’ outcomes has not been well established or synthesized.

Objectives

To outline and compare the principal models and to synthesize current evidence of the effects of multiple person-centered care models on resident outcomes.

Method

Systematic searches were conducted using CINAHL, MEDLINE, PsychoINFO, Evidence Based Medicine Reviews, Cochrane Review databases, and ProQuest Dissertations and Theses using the following keywords (UK and US spellings) individually and in multiple combinations: person-centered care, resident-centered care, client-centered care, individualized care, patient-centered care, culture change, Eden Alternative, Wellspring, Green House, Pioneer Network, dementia, nursing home, assisted living and long-term care. The searches were limited to articles written in English and published from January 1990 to April 2013. Then a manual search of the reference lists of selected relevant articles was conducted.

Results

Twenty-four studies from three countries were reviewed and compared in terms of person-centered interventions, measurement, and resident outcomes. 15 culture change studies for residents who were cognitively intact or with minor cognitive impairment and 9 studies for residents with dementia were reviewed. Across the studies, culture change models had some beneficial effects on residents’ psychological wellbeing. Person-centered dementia care had significant effects on decreasing behavioral symptoms and psychotropic medication use in dementia residents in long-term care.

Conclusion

An agreed upon definition of person-centered care is essential for researchers and clinicians to guide person-centered care development and implementation. Rigorous study design and objective and subjective measurement use are needed for future studies, especially those guided by culture change models. The effectiveness of person-centered care on residents’ bio-psycho-social outcomes like sleep, stress, and physical wellbeing need to be addressed and systematically examined with subjective and objective measures in future studies.     

The mediating role of organizational justice in the relationship between transformational leadership and nurses’ quality of work life: A cross-sectional questionnaire survey

Background

The importance of transformational leadership for nurses’ well-being is increasingly acknowledged. However, there is a paucity of research examining the mechanisms that may explain the relationships between transformational leadership and nurses’ quality of work life.

Objectives

First, to examine two possible psychological mechanisms that link transformational leadership behaviors to nurses’ quality of work life. Second, to study the relationship between nurses’ quality of work life and their work engagement.

Design

Cross-sectional study design.

Settings

The study took place in 47 different hematology, oncology, and hematology/oncology units in France. Participants were nurses and auxiliary nurses.

Participants

343 nurses completed the questionnaire. Surveys were sent to all nurses working in the units. 95% were female, the average age was 36.30 years.

Methods

Nurses were asked to rate their supervisor's transformational leadership style and their perceptions of distributive and interactional justice in the unit. They were also asked to evaluate their own level of quality of work life and their work engagement.

Results

Distributive justice and interactional justice were found to fully mediate the relationship between transformational leadership and nurses’ quality of work life. In addition, nurses’ quality of work life positively related to their work engagement.

Conclusions

Transformational leaders may help ensure nurses’ quality of work life which in turn increases their work engagement. These leadership practices are thus beneficial for both employees and organization.