| 1. |
- Backman, Annica C., 1972-, et al.
(författare)
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Exploring the impact of nursing home managers' leadership on staff job satisfaction, health and intention to leave in nursing homes
- 2023
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702.
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Tidskriftsartikel (refereegranskat)abstract
- Aims and ObjectivesTo explore the impact of nursing home leadership and staffing characteristics on staff job satisfaction, health and intention to leave. BackgroundThe number of older people has outpaced growth in the nursing home workforce worldwide. Identifying predictors with the potential to positively impact staff job satisfaction, health and intentions to leave are important. Leadership of the nursing home manager can be one such predictor. DesignCross-sectional design. MethodsA sample of 2985 direct care staff in 190 nursing homes in 43 randomly selected municipalities in Sweden completed surveys on leadership, job satisfaction, self-rated health and intention to leave (response rate 52%). Descriptive statistics and Generalised Estimating Equations were conducted. The STROBE reporting checklist was applied. ResultsNursing home managers' leadership was positively related to job satisfaction, self-rated health and low intention to leave. Lower staff educational levels were related to poorer health and lower job satisfaction. ConclusionsNursing home leadership plays a significant role in the job satisfaction, self-reported health and intention to leave of direct care staff. Low education levels among staff seem to negatively influence staff health and job satisfaction, suggesting that educational initiatives for less-educated staff could be beneficial for improving staff health and job satisfaction. Relevance to clinical practiceManagers seeking to improve staff job satisfaction can consider how they support, coach and provide feedback. Recognising staff achievement at work can contribute to high job satisfaction. One important implication for managers is to offer continuing education to staff with lower or no education, given the large amount of uneducated direct care workers in aged care and the impact this may have on staff job satisfaction and health. No patient or public contributionNo patient or public contribution was required to outcome measures in this study. Direct care staff and managers contributed with data.
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| 2. |
- Backman, Annica C., 1972-, et al.
(författare)
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Longitudinal changes in nursing home leadership, direct care staff job strain and social support in Swedish nursing homes : findings from the U-AGE SWENIS study
- 2023
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Ingår i: International Journal of Older People Nursing. - : John Wiley & Sons. - 1748-3735 .- 1748-3743. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Promoting healthy work environment as a manager in nursing homes is important to safeguard staff health and well-being as well as care quality when facing increasing demands. The impact of leadership on staff work environment needs further exploration.Objectives: To describe longitudinal changes in nursing home leadership, direct care staff characteristics, job strain and social support.Methods: This study has a repeated cross-sectional design, a five-year follow-up study. Nursing home staff in 181 corresponding units (n = 1253 in 2014 and n = 1176 in 2019) completed surveys about leadership, staff job strain and social support in a five-year follow-up study. Descriptive and regression analyses were conducted.Results: A higher degree of leadership defined by coaching and providing direct feedback to care staff, handling conflicts in a constructive way and having control of the clinical work, was significantly associated with a lower degree of job strain and a higher degree of social support among staff, with stronger associations at follow-up. The proportion of enrolled nurses increased significantly at follow-up.Conclusions: Leadership is increasingly important for staff work environment, especially in times of increased workload and decreasing collegiality and deteriorating work atmosphere at work. Implications for Practice: Stakeholder and policy makers in nursing home care may reflect on how managers' leadership is prioritised in these environments because such leadership is associated with staff job strain and social support. Managers striving to improve the work situation of staff may consider their own role and allow flexibility in how and when the work can be performed.
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| 3. |
- Backman, Annica C., 1972-, et al.
(författare)
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The influence of nursing home managers’ leadership on person-centred care and stress of conscience: A cross-sectional study
- 2021
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Ingår i: BMC Nursing. - : BioMed Central. - 1472-6955. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience.Methods: This study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations.Results: Leadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders.Conclusion: Nursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.
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| 4. |
- Backman, Annica C., 1972-, et al.
(författare)
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The significance of nursing home managers' leadership : longitudinal changes, characteristics and qualifications for perceived leadership, person-centredness and climate
- 2022
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 31:9-10, s. 1377-1388
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: The aim was to explore changes in nursing home managers' leadership, person-centred care and psychosocial climate comparing matched units in a five-year follow-up and to explore the significance of managers' educational qualifications and the ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate in the follow-up data.Background: Leadership has been described as crucial for person-centred care and psychosocial climate even though longitudinal data are lacking. The significance of managerial leadership, its characteristics, managerial qualifications and ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate also needs further exploration.Design: Repeated cross-sectional study.Methods: This study used valid and reliable measures of leadership, person-centred care, psychosocial climate and demographic variables collected from managers and staff n = 3605 in 2014 and n = 2985 in 2019. Descriptive and regression analyses were used. The STROBE checklist was used in reporting this study.Results: Leadership was still positively significantly associated to person-centred care in a five-year follow-up, but no changes in strength were seen. Leadership was still positively significantly associated with psychosocial climate, with stronger associations at follow-up. Six leadership characteristics increased over time. It was also shown that a targeted education for nursing home managers was positively associated with person-centred care.Conclusions: Leadership is still pivotal for person-centred care and psychosocial climate. Knowledge of nursing home managers' leadership, characteristics and educational qualifications of significance for person-centred delivery provides important insights when striving to improve such services.Relevance to clinical practice: The findings can be used for management and clinical practice development initiatives because it was shown that nursing home managers' leadership is vital to person-centred care practices and improves the climate for both staff and residents in these environments.
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| 5. |
- Backman, Annica, et al.
(författare)
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Characteristics of highly rated leadership in nursing homes using item response theory
- 2017
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 73:12, s. 2903-2913
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To identify characteristics of highly rated leadership in nursing homes. Background: An ageing population entails fundamental social, economic and organizational challenges for future aged care. Knowledge is limited of both specific leadership behaviours and organizational and managerial characteristics which have an impact on the leadership of contemporary nursing home care. Design: Cross-sectional. Method: From 290 municipalities, 60 were randomly selected and 35 agreed to participate, providing a sample of 3605 direct-care staff employed in 169 Swedish nursing homes. The staff assessed their managers' (n = 191) leadership behaviours using the Leadership Behaviour Questionnaire. Data were collected from November 2013 - September 2014, and the study was completed in November 2016. A two-parameter item response theory approach and regression analyses were used to identify specific characteristics of highly rated leadership. Results: Five specific behaviours of highly rated nursing home leadership were identified; that the manager: experiments with new ideas; controls work closely; relies on subordinates; coaches and gives direct feedback; and handles conflicts constructively. The regression analyses revealed that managers with social work backgrounds and privately run homes were significantly associated with higher leadership ratings. Conclusion: This study highlights the five most important leadership behaviours that characterize those nursing home managers rated highest in terms of leadership. Managers in privately run nursing homes and managers with social work backgrounds were associated with higher leadership ratings. Further work is needed to explore these behaviours and factors predictive of higher leadership ratings.
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| 6. |
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| 7. |
- Backman, Annica, et al.
(författare)
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Towards person-centredness in aged-care : exploring the impact of leadership
- 2016
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 24:6, s. 766-774
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore the association between leadership behaviours among managers in aged care, and person‐centredness of care and the psychosocial climate.Background: Theory suggests that leadership is important for improving person‐centredness in aged care, however, empirical evidence is lacking.Methods: A cross‐sectional design was used to collect data from Swedish aged care staff (n = 3661). Valid and reliable questionnaires assessing leadership behaviours, person‐centeredness of care and the psychosocial climate were used. Data were analysed using multiple linear regression including interaction terms.Results: Leadership behaviours were significantly related to the person‐centredness of care and the psychosocial climate. The level of person‐centredness of care moderated the impact of leadership on the psychosocial climate.Conclusions and implications for nursing management: The leadership behaviour of managers significantly impacts person‐centred care practice and contributes to the psychosocial climate for both staff and residents in aged care. This study is the first empirically to confirm that middle managers have a central leadership role in developing and supporting person‐centred care practice, thereby creating a positive psychosocial climate and high quality care.
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| 8. |
- Edvardsson, David, et al.
(författare)
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The Umeå Ageing and health research programme (U-age) : exploring person-centred care and health promoting living conditions for an ageing population
- 2016
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Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 36:3, s. 168-174
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this article is to describe the Umeå ageing and health research programme that explores person-centred care and health-promoting living conditions for an ageing population in Sweden, and to place this research programme in a national and international context of available research evidence and trends in aged care policy and practice. Contemporary trends in aged care policy includes facilitating ageing in place and providing person-centred care across home and aged care settings, despite limited evidence on how person-centred care can be operationalised in home care services and sheltered housing accommodation for older people. The Umeå ageing and health research programme consists of four research projects employing controlled, cross-sectional and longitudinal designs across ageing in place, sheltered housing, and nursing homes. The research programme is expected to provide translational knowledge on the structure, content and outcomes of person-centred care and health-promoting living conditions in home care, sheltered housing models, and nursing homes for older people and people with dementia.
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| 9. |
- Lindkvist, Annica
(författare)
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Aspects on latency in HIV-1 infection
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The use of combination antiretroviral therapy (ART) has resulted in a substantial reduction in viremia, a rebound of CD4+ T-cells and increased survival for human immunodeficiency virus type 1 (HIV-1) infected individuals. Unfortunately, ART does not clear the infection or cure the individual from HIV-1. This is due to some unique characteristics of the virus, such as an ability to cause a latent infection in a subset of CD4+ T-cells, and a remarkable genetic variability. This allows HIV to become resistant to treatment under suboptimal conditions (i.e. adherence), and to escape the immune system. The mechanisms of latency needs to be better understood in order to achieve eradication of HIV-1 infection, and the general aim of this thesis was to study different aspects on HIV-1 latency, with a main focus on the circulating pool of HIV-1 infected resting memory CD4+ T-cells. In paper I we set out to analyze whether resting memory CD4+ T-cells could serve as a reservoir of founder or resistant viral strains in patients with or without optimal suppressed viremia. Our results indicated a turn-over and replacement of the cell-pool in untreated and suboptimally treated patients. The memory CD4+ T-cell-pool forms an archive of the viral population, but former resistant viral variants are not always found in these circulating cells. In paper II we wanted to investigate if treatment with high dose intraveneous immunoglobulin (IVIG) in combination with ART could reduce the pool of latently infected resting memory CD4+ T-cells in vivo. Our data suggested a reduction by an average of 68% of the HIV infected latent cell pool. The findings from this proof-ofconcept study suggest that the reservoir became accessible by IVIG treatment through activation of HIV-1 in the latently-infected resting CD4+ T-cells. IVIG will be further evaluated as an adjuvant to effective ART. In paper III, we investigated the impact of DNA methylation inhibitors and NFkB activators on HIV-1 latency in resting memory CD4+ T-cells. Cytosine methylation may be an important component that controls HIV-1 latency. We found that a combination of the DNA methylation inhibitor Aza-CdR and the NFkB activator prostratin can reactivate latent HIV-1 in vitro. Our data indicate that clearance of HIV-1 from infected persons undergoing antiretroviral therapy may be enhanced by inclusion of these inhibitors. In paper IV we wanted to investigate to what extent high mobility group box protein 1, HMGB1, alone or in complex with TLR ligands activate latent HIV-1 in vitro. HMGB1 is an abundant intracellular protein found in all cells in the body. It contributes to immune activation and has been suggested to have an important impact on HIV-1 pathogenesis. We found that recombinant HMGB1, or HMGB1 as part of necrotic extract, in complex with TLR stimulating ligands LPS, CpG ODN and flagellin, increased HIV-1 replication in vitro, as compared to HMGB1 or ligands alone, in a model of latent HIV-1 infection. Our in vivo data suggest that a turn-over of the latent HIV-1 reservoir in resting memory CD4+ T-cells may appear in the natural course of HIV-1 infection in untreated and in suboptimally treated subjects. It is also possible to induce a decrease of the viral reservoirs by additional treatment, in our case IVIg, in patients with controlled viremia. Our in vitro data point at new possibilities to activate latent HIV-1 and further exploration of these mechanisms should be considered.
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| 10. |
- Lindkvist, Annica, et al.
(författare)
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Reduction of the HIV-1 reservoir in resting CD4+ T-lymphocytes by high dosage intravenous immunoglobulin treatment: a proof-of-concept study
- 2009
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Ingår i: AIDS research and therapy. - : Springer Science and Business Media LLC. - 1742-6405. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The latency of HIV-1 in resting CD4+ T-lymphocytes constitutes a major obstacle for the eradication of virus in patients on antiretroviral therapy (ART). As yet, no approach to reduce this viral reservoir has proven effective. METHODS: Nine subjects on effective ART were included in the study and treated with high dosage intravenous immunoglobulin (IVIG) for five consecutive days. Seven of those had detectable levels of replication-competent virus in the latent reservoir and were thus possible to evaluate. Highly purified resting memory CD4+ T-cells were activated and cells containing replication-competent HIV-1 were quantified. HIV-1 from plasma and activated memory CD4+ T-cells were compared with single genome sequencing (SGS) of the gag region. T-lymphocyte activation markers and serum interleukins were measured. RESULTS: The latent HIV-1 pool decreased with in median 68% after IVIG was added to effective ART. The reservoir decreased in five, whereas no decrease was found in two subjects with detectable virus. Plasma HIV-1 RNA >or= 2 copies/mL was detected in five of seven subjects at baseline, but in only one at follow-up after 8-12 weeks. The decrease of the latent HIV-1 pool and the residual plasma viremia was preceded by a transitory low-level increase in plasma HIV-1 RNA and serum interleukin 7 (IL-7) levels, and followed by an expansion of T regulatory cells. The magnitude of the viral increase in plasma correlated to the size of the latent HIV-1 pool and SGS of the gag region showed that viral clones from plasma clustered together with virus from activated memory T-cells, pointing to the latent reservoir as the source of HIV-1 RNA in plasma. CONCLUSION: The findings from this uncontrolled proof-of-concept study suggest that the reservoir became accessible by IVIG treatment through activation of HIV-1 gene expression in latently-infected resting CD4+ T-cells. We propose that IVIG should be further evaluated as an adjuvant to effective ART.
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