Aim This review was conducted to map leadership styles that positively impact patients, professionals and institutions. Background Leadership is a topic widely studied because it is a fundamental skill in establishing favourable work environments, in addition to enabling nurses to influence their team in the search for better results. Therefore, a synthesis of the various studies produced to date is essential for nurses, managers and researchers to understand the different styles of leadership that positively influence organizational results, so they can choose the style they deem most appropriate. Evaluation An integrative literature review retrieved articles from five databases, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The level of evidence and its quality were assessed using the criteria of the Joanna Briggs Institute. Key issues Thirty‐five studies were included, 18 of which reported the influence of leadership styles on patients (safety), nine on professionals (burnout) and eight on institutions (turnover and absenteeism). Conclusion Transformational leadership had positive results for patients, professionals, and institutions alike. Implications for Nursing Management The results showed the need for nurses to improve their leadership skills, especially in the transformational style, to achieve positive results.

Aim To test a theoretical model aiming to understand which characteristics of the professional nursing practice environment most affect patients, professionals and institution outcomes. Design A cross‐sectional and correlational study, using a structural equation model. Methods One thousand seven hundred and seventy‐three staff nurses were recruited using convenience sampling in five Brazilian hospitals from November 2017 to July 2018. Structural equation modelling was used to assess the relationship between the characteristics of the nursing work environment and patients (climate of safety and quality of care), nursing professionals (job satisfaction and emotional exhaustion) and institutions (intention to leave the job) outcomes. The model was tested using the partial least squares method, considering the bootstrapping technique to estimate the results. The path coefficients and their respective 95% confidence intervals were calculated. The quality of fit of the structural model was assessed by calculating the coefficient of determination (R2), the predictive validity coefficient (Q2) and the effect size (f2). Results The characteristics that most affected the outcomes for patients were Nurse manager ability, leadership and support of nurses (λ=0.27), and Staffing and resource adequacy (λ=0.26); for nursing professionals, Staffing and resource adequacy (λ=−0.19), and Collegial nurse–physician relations (λ=0.19); and for institutions, Nurse manager ability, leadership and support of nurses (λ=−0.10), and Collegial nurse–physician relations (λ=−0.10). Conclusion The characteristics of the professional nursing practice environment that most contribute to achieving better outcomes include nurse manager ability, leadership and support of nurses, staffing and resource adequacy, and collegial nurse–physician relations. Impact This study allowed us to assess which strategies should be prioritized in the professional nursing practice environment to achieve better results. Thus, investment in the training of leadership, in the adequacy of resources, and in physician–nurse relations will bring better results for patients, nursing professionals, and institutions.

Objective To evaluate the influence of grandmothers of infants on exclusive breastfeeding, from their perspective.Methods A descriptive cross-sectional study was carried out with 91 women from a hospital in the inland state of São Paulo. By means of a questionnaire, the following data were collected: sociodemographic data of the grandmother, mother and child; duration of exclusive breastfeeding of daughter or daughter-in-law; information on kinship of participant and grandchild; kind of help provided by grandmother; and knowledge about breastfeeding.Results The prevalence of infants on exclusive breastfeeding at two months was 35.17%; a total of 67.3% of grandmothers considered it important to give food to babies before six months of life, and 54% considered relevant breastfeeding at regular intervals. Moreover, 40% believed in weak milk and were not aware of signs of sufficient breast milk. Of the grandmothers interviewed, 69% had already offered tea and water to their grandchildren. In the univariate analysis, the maternal grandmother was more involved and close to the pair mother and child.Conclusion The presence of grandmothers influences in exclusive breastfeeding.

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Resumo Objetiv Avaliar o ambiente hospitalar onde a enfermagem exerce sua prática comparando hospitais públicos e privados e descrever as características que receberam avaliação desfavorável (≤ 2,5 pontos) na percepção dos profissionais. Métodos Estudo comparativo e transversal realizado em cinco hospitais (dois públicos - A e B e três privados - C, D e E) de um município do interior do estado de São Paulo, com 1773 profissionais de enfermagem. Os instrumentos utilizados foram: ficha para caracterização da amostra e a versão brasileira da Practice Environment Scale. Na análise dos dados, foram utilizadas estatísticas descritivas e inferenciais. Para comparar os hospitais foi utilizado o teste Kruskall Wallis, seguido pelo pós-teste de Dunn e a regressão multinomial. Resultados Na comparação dos hospitais, os hospitais D e E alcançaram médias superiores aos demais e diferenças significantes (p<0,0001) foram obtidas com relação às cinco subescalas do instrumento utilizado. Na regressão multinomial, o hospital D obteve 5,8; o E 5,2; o C 3,0 e o A 2,7 chances de possuir um ambiente mais favorável, quando comparados ao hospital B. Os itens com nota inferior a 2,5 foram associados, especialmente, a falta de oportunidade de desenvolvimento, reconhecimento, gestão participativa e dimensionamento adequado. Conclusão Os hospitais privados apresentaram melhor desempenho quando comparados aos públicos e as características que receberam pior avaliação estavam relacionadas à participação dos enfermeiros nos assuntos hospitalares, fundamentos voltados para a qualidade, suporte dos gestores à equipe e adequação de recursos.