How can leadership influence the quality ofcare in a health-care organization?

Objective:This study focuses on how leadership could influence the quality of care in a health-care organization.Methods:The concept of leadership and quality are analyzed.In addition,issues concerning how leadership can influence quality of care through the effect on the organizational culture and the engagement of both nurses and patients are discussed.Results:Leadership is the pivotal factor in the improvement of quality through the effect on the organizational culture and the engagement of both nurses and patients.Conclusions:Leadership can influence the quality of care directly and indirectly.The organization and the leaders should know the importance of effective leadership to a better work environment,facilitate the implementation of the new mode of nursing,and provide best services to the patients.     

Physicians’ leadership styles in rural primary medical care: How are they perceived by staff?

Aim. This study investigates which leadership styles can be identified among general practice lead physicians and how they are associated with and predicted by staff and context characteristics like profession, gender, age, work experience, and team size. Method/material. In a cross-sectional study self-administered questionnaires were distributed to staff physicians (42% females) and support staff (98% females) at 101 primary health care centres in North Norway. A total of 127 and 222, respectively, responded (response rate 59%). Items were ranked on Likert scales (range 1–5). Results. Analysis revealed three significantly different styles (mean scores/Cronbach''s alpha): change style (3.36/0.898), task style (3.17/0.885), and relation style (2.88/0.900). The lead physicians were perceived as practising change style the most and relation style the least. Males experienced significantly more of all three styles. Support staff scored lowest for all styles. Age was negatively correlated with relation style and change style, while work experience was negatively correlated with change style. No significant association was found between styles and team size. Conclusion. Leadership in rural general practice can be identified in terms of task, relation, and change styles. Change style is the most perceived style. Males seem to be most attentive to leadership styles. However, within the staff physician group, there is less difference between genders. Support staff scores lowest for all styles; this might indicate either less need for leadership or dissatisfaction with leadership. Age and work experience seem to reduce employees’ attention to relation and change styles, indicating that maturity reduces needs for these leadership styles. Due to growing demands for leaders to take care of efficiency and change in general practice, more young female physicians, and more diverse staff groups, these findings may be useful to understand leadership and leadership training for general practice.Key Words: Context, general practice, lead physicians, leadership style, Norway, rural medicine, staff gender, staff maturity, staff professionLeadership styles practised by lead physicians in rural general practice are poorly investigated. This study has revealed that:

• Styles reflect general theory but are modified in PHC organizations.
• The leadership style “Change style” is most practised.
• Male staff are most attentive to leadership.
• Support staff experience least of all styles.

Staff maturity, such as age and experience, reduces staff''s need for leadership.     

How is sleep quality affected by the psychological and symptom distress of advanced cancer patients?

The aim of this study was to assess the relationship between sleep quality, pain, psychological distress, cognitive status and post-traumatic experience in advanced cancer patients. Participants were 82 advanced cancer patients referred to a palliative care unit for control of pain and other symptoms. A variety of assessment tools were used to examine the prevalence of sleep disturbance, the severity of pain and depression, hopelessness, cognitive function and quality of life. Using the Pittsburgh Sleep Quality Index (PSQI) 96% of patients were 'poor sleepers'. Statistically significant associations were found between PSQI and the SF-12 (Short Form-12) Quality of Life Instrument (MCS, P < 0.0005, PCS, P < 0.0005), depression (Greek Depression Inventory) (P < 0.0005) and hopelessness (Beck Hopelessness Scale) (P = 0.003). Strong associations were also found between PSQI and IES-R (Impact of Event Scale-Revised) (P = 0.004). The strongest predictors of poor sleep quality in this model were MCS (P < 0.0005), PCS (P < 0.0005) and IES-R (P = 0.010). Post-traumatic experience and quality of life seemed to be the strongest predictors of sleep quality in a sample of advanced cancer patients referred for palliative care.     

How accurate are parental chronic pain histories provided by offspring?

Previous work suggests possible relationships between offspring-reported parental history of chronic pain (CP) and offsprings' personal chronic pain experience. This study examined reliability of offsprings' reports of parental CP history based on direct comparison with confirmed parental reports. Participants included 108 male and female college students who completed a questionnaire assessing presence/absence and locations of any past or present CP lasting greater than 3 months. Information on maternal and paternal CP history was obtained using a similar questionnaire based both on offspring reports and on reports provided directly by offsprings' parents (for 75 participants). Results indicated relatively high sensitivity (0.79-0.94) but modest specificity (0.55-0.63) for offspring reports of parental CP history, and a tendency to overestimate the incidence of CP in both parents. Significant (Ps<0.001) but moderate inter-rater reliability was noted for judgments of parental CP history (kappas=0.41-0.53). Reliability generally decreased when offspring were asked to report on specific locations of parental CP. Offspring-reported parental CP history predicted (Ps<0.05) presence and number of locations at which offspring reported having personally experienced CP, consistent with previous studies. Results indicated that these relationships were not mediated by social desirability, negative affect, or catastrophizing cognitions. In contrast to results for offspring-reported data, confirmed parental CP history reports failed to predict offsprings' personal CP history. These results raise questions as to the validity of previous findings of relationships between family pain history and individuals' own experience of CP.     

How long and how much are nurses now working?

OBJECTIVE: Extended work schedules-those that vary from the standard eight hours per day, 35 to 40 hours per week-are common in nursing and contribute to problems with nursing recruitment and retention, in addition to compromising patient safety and the health and well-being of nurses. This study describes the nature and prevalence of such schedules across nursing settings. METHODS: Quantitative survey data collected as part of the Nurses Worklife and Health Study were analyzed. The sample consisted of 2,273 RNs. Demographic data, information about respondents' primary jobs (position, workplace, and specialty), and specific work schedule variables were analyzed, including data on off-shifts, breaks, overtime and on-call requirements, time off between shifts, and how often respondents worked more than 13 hours per day and on scheduled days off and vacation days. Respondents were also asked about activities outside of work, commuting time, and other non-nursing activities and chores. RESULTS: More than a quarter of the sample reported that they typically worked 12 or more hours per day, as did more than half of hospital staff nurses and more than a third of those with more than one job. A third of the total sample worked more than 40 hours per week, and more than a third worked six or more days in a row at least once in the preceding six months. Nearly a quarter rotated shifts.Almost one-quarter of nurses with more than one job worked 50 or more hours per week, and they were more likely to work many days consecutively, without sufficient rest between shifts, and during scheduled time off. Single parents were as likely as those with more than one job to work 13 to 15 hours per day, 50 to 60 hours or more per week, and many days consecutively. Seventeen percent of all nurses worked mandatory overtime, as did almost a quarter of the single parents. Nearly 40% of the total sample and more than 40% of hospital staff nurses had jobs with on-call requirements. CONCLUSIONS: The proportion of nurses who reported working schedules that exceed the recommendations of the Institute of Medicine should raise industry-wide concerns about fatigue and health risks to nurses as well as the safety of patients in their care.     

Nursing-sensitive safety and quality outcomes: the taming of a wicked problem?

There are tremendous opportunities associated with the increasing interest in outcomes that are sensitive to the effects of nursing. However, the challenges in realizing these opportunities are significant, and can be characterized as “wicked". Taming these challenges requires that we manage highly interdependent processes and techniques, including health information technologies.     

How effective and valued are nurse consultants in the UK?

The introduction of nurse consultant posts has heralded a dramatic change in nursing. Many factors have influenced this change. Documents such as the UKCC's the Scope of Professional Practice (UKCC 1992a), and NHS reforms are among them. The aim of this article is to explore the effectiveness of nurse consultants.     

How healthy are our nurses? New and registered nurses compared

This study examined the health behaviour of nursing staff, comparing registered and pre-registered nurses in terms of their self-reported health and lifestyle behaviour. In total, 325 pre-registered nurses and 551 registered nurses, based at the same university teaching hospital and located within an acute NHS trust, completed a self-administered health and lifestyle questionnaire survey. With the exception of smoking behaviour, registered nurses generally had a healthier lifestyle compared with pre-registered nurses. However, when examining the overall health profile of the sample, the study reveals that there is room for improvement in the health and lifestyle behaviour exhibited by both registered and pre-registered nurses. Almost half of the sample failed to meet public health recommendations for levels of physical activity, almost two-thirds did not consume five portions of fruit or vegetables daily and almost half ate foods that were high in fat and sugar content on a daily basis. These findings are alarming given the current government emphasis on the health of NHS staff and the important role that nurses play in influencing lifestyle choices among their patients. There is an urgent need to target education and support services to improve the diet and exercise habits of nursing professionals.