Developing and sustaining nursing leadership that fosters a healthy work environment in health care

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Developing and sustaining nursing leadership
that fosters a healthy work environment in health
care

• Professor Alan Pearson
• Dr Heather Laschinger
• Kylie Porritt, Zoe Jordan,
• Donna Tucker, Dr Leslye long
• HCR 2(7) 2004 145-208

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A comprehensive systematic review

• A JBI comprehensive systematic review that
  examined evidence of feasibility, meaningfulness
  and effectiveness.

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The review sought to determine

• Which leadership attributes foster leadership and
  lead to a healthy work environment?
• What impact/influence does the work environment
  have in developing and sustaining nursing
  leadership to produce positive outcomes in the
  health care setting?

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Included study designs

• Quantitative and Qualitative research that
  addressed feasibility, meaningfulness and
  effectiveness.
• Discussion papers were flagged for consideration.

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Included participants

• Leaders, those affected by positive leadership
  attributes, and those affected by system and
  policy constructs within the health care
  environment.
• Specifically, staff and patients

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Included Interventions

• Positive leadership attributes
• System and policy constructs

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Included outcome measures

• Any outcome considered to lead to the creation of
  a healthy work environment
• Positive nursing, patient and system outcomes,

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Search Strategy

• CINAHL(to December 2003)
• MEDLINE (to December 2003)
• Current Contents Library (to December 2003)
• Cochrane (to December 2003)
• PsychINFO (to December 2003)
• Embase (to December 2003)
• Social Sciences Abstracts (to December 2003)

• Econ lit (to December 2003)
• ABI Inform Global (to December 2003)
• ERIC (to December 2003)
• The search for unpublished studies included
• Dissertation Abstracts International (to December
  2003)

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Methodological Quality
Studies that met the inclusion criteria were
grouped into one of the following categories

• experimental
• descriptive
• descriptive-correlational
• Qualitative and
• text / opinion papers.

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Qualitative Appraisal

• There is congruity between the stated
  philosophical perspective and the research
  methodology
• There is congruity between the research
  methodology and question or objectives
• There is congruity between the methodology and
  methods of data collection
• There is congruity between the methodology and
  representation and analysis of data
• There is congruity between the methodology and
  interpretation of results
• There is a statement locating the researcher
  culturally or theoretically
• The influence of the researcher on the research
  and vice-versa is addressed
• Participants and their voices are adequately
  addressed
• The research is ethical according to current
  criteria, or for recent studies there is evidence
  of ethical approval by an appropriate body
• Conclusions drawn in the report appear to flow
  from the analysis, or interpretation of the data.

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Data extraction study details
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Data extraction findings
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Synthesis

• Statistical pooling of quantitative results was
  not possible, findings were presented in
  narrative form.
• Data synthesis of qualitative and textual data
  was performed using the JBI-QARI and JBI-NOTARI
  software packages

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Results

• Of 115 papers, 48 were included
• 1 systematic review
• 2 experimental studies
• 33 papers reporting 35 descriptive-correlational
  studies
• 5 interpretive and critical papers (29 findings)
• 7 textual papers (13 conclusions)

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Results

• 8 synthesized findings
• Three step process
• Theme identification,
• Categorization,
• Synthesis of categories to produce a synthesized
  finding
• Working backwards.

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Synthesized finding 1

• Health care teams that collaborate can improve
  outcomes for staff and patients resulting in
  creating a healthier work environment.

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Synthesized finding 2

• Leaders who continue with further education and
  gain a sound knowledge of leadership develop the
  necessary skills to improve the work environment
  for their staff.

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Synthesized finding 3

• Leaders who exhibit characteristics consistently
  associated with emotional intelligence are likely
  to have a positive impact on staff, patient and
  organisational outcomes.

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Synthesized finding 3a
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Synthesized finding 3b
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Synthesized finding 3c
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Synthesized finding 4

• Leaders need to have an understanding of the key
  factors associated with producing a positive
  organisational climate in order to have an impact
  on producing positive staff outcomes.

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Synthesized finding 4
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Synthesized finding 5

• To improve their role in leadership, leaders
  should continue with their professional
  development.

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Synthesized finding 6

• An element of the leadership role is to
  encourage staff to undertake professional
  development activities.

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Synthesized finding 6
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Synthesized finding 7

• Leaders who exhibit certain qualities and
  behaviours are likely to yield positive outcomes
  for staff and patients.

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Synthesized finding 7b
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Synthesized finding 7c
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Synthesized finding 8

• A supportive structure within an organisation
  can benefit people in leadership roles and assist
  those in leadership roles to provide support for
  their staff.

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Synthesized finding 8
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Discussion

• Leadership has been identified as a contributor
  toward optimal work environments. The effect is
  multi directional.
• Key characteristics were extensively catalogued,
  for nurses and systems

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Implications for a healthy work environment

• Different leadership styles can lead to positive
  outcomes
• Combining styles contributes
• Characteristics and behaviours of leaders can
  improve staff and patient outcomes
• Combining positive attributes strengthens the
  effect
• Structures that enable leaders to empower staff
  can increase positive outcomes

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Implications for research

• No data was able to be synthesized for
  organisational outcomes

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• Alan Pearson, Heather Laschinger, Kylie Porritt,
  Zoe Jordan, Donna Tucker, Leslye long Developing
  and sustaining nursing leadership that fosters a
  healthy work environment in health care, Health
  Care Reports, 2(7) 2004, 145-208
• Chalmers TC, Lau J. Meta-analytic stimulus for
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• Chalmers I, Haynes RB. Reporting, updating, and
  correcting systematic reviews of the effects of
  health care. In Chalmers I, Altman DG, eds.
  Systematic reviews. London BMJ 199586-95.
• L'Abbe KA, Detsky AS, O'Rourke K. Meta-analysis
  in clinical research. Ann Intern Med. 1987
  107224-33.
• Oxman AD, Cook DJ, Guyatt GH. Users' guides to
  the medical literature. VI. How to use an
  overview. Evidence-Based Medicine Working Group.
  JAMA. 1994 2721367-71.

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Healthy work environment defined

• Among nurses
• The promotion of physical and mental health as
  evidenced by observable positive health and well
  being, job and role satisfaction, desirable
  recruitment and retention rates, low absenteeism,
  illness and injury rates, low turn over, low
  overtime, positive inter-staff relationships, low
  unresolved grievance rates, opportunities for
  development, low burn out and job strain,
  participation in decision making, autonomous
  practice, and control over practice and work
  role, evidence of strong clinical leadership,
  demonstrated competency and positive perceptions
  of the work environment including perceptions of
  work-life balance.

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Healthy work environment defined

• Among patients
• The promotion of physical and mental health as
  evidenced by observable positive health and
  well-being, satisfaction and a decrease in
  complication rates and mortality.
• Within health systems
• The reduction of length of stay, cost per case
  within acceptable range and the delivery of
  observable high quality patient care.

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• No of reviews in medline
• Key term META-ANALYSIS
• YEAR of ENTRY 89

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Quantitative Reviews

• 1979 Meta analysis of perinatal trials
• 1988 Publication of a series of meta analyses in
  Br J Obstet and Gynaecol
• 1993 The number of systematic reviews published
  annually has increased by over 500
• Today quantitative reviews have associated
  methods groups, resources, education, training,
  critical appraisal, implementation and guideline
  development groups.
• Quant reviews are no longer the sole domain of
  researchers or information specialists

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Qualitative Reviews

• No current terms in Medline
• Currently qual reviews remain largely in the
  domain of information specialists and qual
  researchers.
• Existing methods include systematic IT guided
  approaches, and normalised iterative approaches
• Currently low numbers of associated methods
  groups, resources, education, training, critical
  appraisal, implementation and guideline
  development groups.
• Currently no formally adopted method by the
  Cochrane QRMG