Safeguarding the patient in municipal healthcare—A hermeneutic focus group study of Nordic nursing leadership

Abstract

This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractAim: This study illuminates the meaning and purpose of clinical presence in nursing leadership in municipal home care from the first-line nurse manager's own perspective.Background: Being a first-line nurse manager in the context of home care is demanding due to demographic changes and an ever-increasing number of elderly suffering from chronic diseases. Leading in this context entails leading from a distance because patients live and receive care in their homes. First-line nurse managers express the importance of clinical presence. However, there is a paucity of studies from home care of the meaning and purpose of presence. The theory of caritative leadership and the model of caring in nursing leadership served as the starting point for this study.Methods: Hermeneutic abductive approach using a purposive sample of three semistructured focus group interviews with 11 first-line nurse managers in home care in three Nordic countries.Result: This study shows that first-line nurse managers described the meaning and purpose of their clinical presence in home care as safeguarding the patient by taking overall responsibility for care, securing the patients' voices, building and maintaining trustful relations, and securing a sensible economy. Conclusion:Our findings indicate that clinical presence serves the purpose of taking the overall responsibility for care and safeguarding the patient. Presence is perceived a necessity to verify staff providing the best possible care. First-line nurse managers acted metaphorically as a shield to protect patient care, which is the main concern in their leadership. The findings add new knowledge to the significance of caring in nursing leadership and the theory of caritative leadership. Implications for Nursing Management:First-line nurse managers need to be clinically present in order to safeguard the patient and to fulfil their threefold responsibilities for the patient, the staff and the economy. This study might also contribute to the political discussion concerning why nurses has to be first-line nurse managers and cannot be replaced by economists. K E Y W O R D Scaring, caritative leadership, clinical presence, hermeneutics, municipal home care | 1243 SOLBAKKEN Et AL.

First-Line Nurse Managers' Challenges at the Crossroads of Norwegian Health Care Reforms

“…Our study contributes to an understanding of the meaning and purpose of clinical presence from the FLNM perspective as they serve purposes other than engaging in daily nursing activities to alleviate nursing shortages or save the economy. 7 Our findings show that FLNMs' clinical presence serves the purpose of taking the overall responsibility for care in their units and thereby safeguarding the patients. 7 When clinically present, FLNMs describe an opportunity to secure patients' voices, build and maintain trust-based relations with their staff, and ensure that the unit's financial consumption is reasonable.…”

“…7 Our findings show that FLNMs' clinical presence serves the purpose of taking the overall responsibility for care in their units and thereby safeguarding the patients. 7 When clinically present, FLNMs describe an opportunity to secure patients' voices, build and maintain trust-based relations with their staff, and ensure that the unit's financial consumption is reasonable. Because they are nurses, these FLNMs are able to identify and prevent adverse events and suffering related to care.…”

“…We also describe strategies to maintain their responsibilities in patient care. The Norwegian perspective in this article is based on our quantitative, theoretical, and qualitative studies [2][3][4][5][6][7] in the context of Nordic municipal health care (Norway, Sweden, and Finland) with similar welfare models.…”

“…All the FLNMs stated a wish and a need for relations with their superior to be characterized by trust, personal support, and 2-way dialogue in order for them to manage the changes caused by the new reforms. 7 They describe themselves as constituting an informal network of other FLNMs for mutual support; however, the FLNMs participating in formal, established, and continuously arranged leadership networks felt empowered and supported. When FLNMs gain confidence in leadership, they extend the way they see themselves as a part of a broader perspective, especially from the perspective of the patients and their families, which is understood as a bottom-up perspective.…”

Exploring the role of managers in quality and safety work in nursing homes and homecare services; A multiple case study

“…Arenas and time for competence development were described by both managers and employees as difficult due to lack of time and the need to prioritise patient-related tasks. In addition, the homecare setting by its nature has few meeting points with employees (Solbakken et al, 2019;Solbakken et al, 2021). The physical and technological challenges mentioned by managers and employees were the lack of computers and unreliable internet; these presented a potential risk of harm due to insufficient documentation (Paper II).…”