The impact of team climate for innovation on well-being and stress in elderly care Aims To investigate the impact of team climate in providing support for innovation on well-being and stress and to explore whether well-being is a mediating variable between team climate and negative stress. Background The well-being of the nursing staff needs to be improved in elderly care as well as the quality of the care. Team work may be a way of addressing both needs. Method A questionnaire was completed by auxiliary nurses and nurses' aides (n = 329) within elderly care in Sweden. Structural equation modelling was used to test the relationships among team climate, well-being and stress. Results The perceived team climate has a significant positive correlation with well-being and a significant negative correlation with stress reactions. The structural equation modelling suggested that well-being is a mediating variable between team climate and stress. Conclusion A better team climate providing support for innovation may increase well-being and decrease stress reactions among nursing staff. Implications for nursing management: Interventions that improve the team climate and provide support for innovation may increase the possibilities for growth and self-actualization of the employees that, in turn, make them more qualified to deal with stress.

Aims: This study sets out to investigate direct care staff's views of their need for support, supervision, and training in their practice in day care settings when supporting daily occupations among developmentally disabled persons.

Background: The first line staff are considered as having a prominent role in the successful delivery of service.

Methods: Three municipalities, one urban and two rural areas in southern Sweden, were chosen for the study. The studied population n = 81 consisted of 94.1% of all staff employed in day activities units supporting the clients' daily occupations or community-integrated, sheltered work employment. The data were collected by means of a questionnaire.

Findings: This material identified the staff's perceived work role, and their needs for support, supervision, and training in the areas of communication, environment adaptation, individual activation and training methods, with regard to learning disabilities and special needs.

Conclusions: Care managers should focus upon preparation of staff support programmes to improve the quality and efficiency in this area of care.

Aim This paper presents a study that explores how newly qualified registered nurses experience their leadership role in the ward-based nursing care team. Background A nurse's clinical leadership affects the quality of care provided. Newly qualified nurses experience difficulties during the transition period from student to qualified professional and find it challenging to lead nursing care. Methods Twelve nurses were interviewed and the transcribed texts analysed using qualitative content analysis to assess both manifest and latent content. Results Five themes were identified: feeling stranded; forming well-functioning teams; learning to lead; having the courage, strength, and desire to lead; and ensuring appropriate care. The findings indicate that many factors limit nurses’ leadership but some circumstances are supportive. Conclusion The leadership prerequisites for newly registered nurses need to improve, emphasizing different ways to create a supportive atmosphere that promotes professional development and job satisfaction. Implications for nursing management To increase nurse retention and promote quality of care, nurse managers need to clarify expectations and guide and support newly qualified nurses in a planned way.

Aim To describe and compare pressure ulcer prevalence in two county councils and concurrently explore Nurse Managers perspective of contextual factors in a hospital organization. Background Despite good knowledge about risk factors and prevention of pressure ulcers, the prevalence of pressure ulcers remains high. Nurse Managers have a key role in implementing evidence-based practice. Methods The present study included five hospitals in two Swedish county councils: county council A (non-university setting) and county council B (university setting). A pressure ulcer prevalence study was conducted according to the methodology developed by the European Pressure Ulcer Advisory Panel. The Nurse Managers answered a (27-item) questionnaire on contextual factors. Results County council B had significantly less pressure ulcers grade (2–4) (7.7%) than county council A (11.3%). The Nurse Managers' assessed only two out of the 27 general contextual items significantly differently. Some significant differences were observed in ward organization. Conclusions In county council B, the Nurse Managers seemed more aware of prevention strategies compared with Nurse Managers in county council A. The Nurse Managers should take more responsibility to develop the prerequisite for quality improvement in nursing. Implication for nursing management Nursing outcomes (e.g. pressure ulcers) should be incorporated into national quality registries for benchmarking and Nurse Managers competence in evidence-based practice and research methodology increased.

AIM: The aims of the study are to explore workplace violence perpetrated by patients or visitors from the perspective of hospital ward managers and to describe how ward managers perceive their leadership role and manage related incidents.

BACKGROUND: Few studies focus on workplace violence from the perspective of ward managers even though they are the closest managers to the operational staff.

METHOD: Fifteen semistructured interviews were analysed using qualitative content analysis.

RESULTS: Four categories emerged: the face of workplace violence, a two-fold assignment, strive towards readiness to act, and managing incidents.

CONCLUSION: While the most common acts of workplace violence are considered less serious and related to patients' medical conditions or dissatisfied visitors, hospital organizations focus on serious but rarely occurring incidents. Consequently, ward managers have limited opportunities to ensure a safe work environment on an everyday basis.

IMPLICATIONS FOR NURSING MANAGEMENT: To support ward managers' occupational safety and health management, workplace violence prevention and management should be acknowledged as an important responsibility for senior management in hospitals. It is important to identify incidents that most likely will occur at the wards and to create strategies related to those incidents. Strategies could include risk assessments, prevention, evaluation, education and reflection combined with, for example, scenario training.

AIM: The aim of this study was to explore aspects that are important for the integration of preceptorship and processes for recruitment and retention of nurses.

BACKGROUND: Shortage of nurses is a global concern that has a major impact on healthcare systems around the world. However, earlier research has not considered whether preceptorship of nursing students can be an integral part of recruitment and retention of nurses.

METHOD: A descriptive design with a qualitative approach was used. Semi-structured interviews were conducted with ten preceptors and six ward managers in different healthcare specialties in Sweden.

RESULTS: Three aspects were found central for integrating preceptorship with recruitment and retention: perceptions of preceptorship, the organization of preceptorship, and the way preceptorship operates in relation to recruitment and retention strategies.

CONCLUSION: The findings suggest that preceptorship and recruitment strategies could both benefit from being integrated.

IMPLICATIONS FOR NURSING MANAGEMENT: It is central for nursing managers to develop organizational practices that enable the integration of preceptorship with recruitment and retention of nurses. This could increase the quality of both preceptorship and the work environment in general.

Aim The aim of the study was to explore the theoretical perspectives in use by approved clinical nursing supervisors in Sweden. Background For the time being, we know little of the theoretical perspectives in use on a daily basis by the clinical nursing supervisors in Sweden. Methods A questionnaire (n=49) and follow-up telephone interviews (n=14) were used. Data analysis was made by descriptive statistics and qualitative content analysis. Results The result from the questionnaire showed that the supervisors often used and combined different theoretical perspectives with origins in nursing, education and psychology. Surprisingly, one-fourth of the respondents did not state any nursing theoretical perspective in use during clinical nursing supervision. The result from the interviews revealed that the theory of Katie Eriksson (1987) was the most commonly used nursing perspective. Conclusion As the overall aim for clinical nursing supervision is to improve nursing for the patient/family, the supervisor’s competence in nursing is essential. Given this fact, and that only three-quarters of the approved clinical nursing supervisors stated a use of theoretical nursing perspective when supervising, there is obviously a need for further investigations in this area. In addition, there is also a need for approved Swedish clinical nursing supervisors, to further become aware of the theoretical perspective in use that supports their clinical nursing supervision. Clinical nursing supervision is a multifaceted activity that needs to be supported by different nursing theoretical perspectives including physical, emotional, intellectual, spiritual as well as socio-cultural aspects.

The study investigated whether psychosocial work conditions, professional network, job support, social network and support, sick-leave and salary were associated to work stress in nurses in chief manager positions above ward level and physicians in clinical director positions. A sample consisting of 205 nurses and 274 physicians in chief managers’ positions at higher structural level answered a questionnaire. Odds ratios were used for estimating the bivariate association between work stress and psychosocial resources. The result showed that both nurse managers (OR 6.8; 95% CI: 3.5-13.5) and clinical directors (OR 6.7; 95% CI: 3.6-12.5) exposed to high job demands had a significantly higher probability of high level of work stress. The results also indicated that the available psychosocial resources taken together inside and outside work did not balance the experienced work stress in nurse managers and the clinical directors who were exposed to high work demands. No relation was found between work stress and sick-leave and salary.

AIM: To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons. BACKGROUND: Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care. METHOD: Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis. FINDINGS: A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance. CONCLUSION: The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice. IMPLICATIONS FOR NURSING MANAGEMENT: The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation

Aims - To describe and compare nurses’ perceptions of their professional practice environment in seven countries. Background - There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses’ ability to perform and are linked to differing nurse and patient outcomes. Methods - A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results - Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions - Although between-country differences in nurses’ professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management - The results support investment to improve nurse’s work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

AIMS: Describing newly graduated nurses' experiences of the intervention graduate guidance nurses.

BACKGROUND: Newly graduated nurses need support to become established in the profession. The intervention was initiated to empower and support in the professional role.

METHODS: A qualitative case study conducted with semi-structured interviews, using a thematic content analysis.

RESULTS: One overarching theme "Organizational prerequisites, consisting of three themes occurred: "Activator" involved that the graduate guidance nurse was the activator creating a clear structure and the wards became more attractive workplaces. "Supportive nursing" meant that the graduate guidance nurse constituted an important support function which ensured patient safety. "Professional development" created the opportunity for professional growth.

CONCLUSION: Newly graduated nurses' experiences shows that the creation of an organizational structure enabled the graduate guidance nurses to be an important support and contributed to professional development.

IMPLICATIONS FOR NURSING MANAGEMENT: In healthcare organizations, strategic decisions, management support, and clear goals are important to create the organizational conditions to improve safer care. Support from experienced nurses is a large enabler in supporting newly graduated nurses developing in their profession. The results of the current study can be transferred to other similar healthcare organizations and can be supporting managers who plan to initiate support to newly graduated nurses.

Introduction The adoption of evidence-based guidelines within the mental health field has been slow. Changing inadequate practice is therefore a formidable challenge for mental health-care managers. Aim To explore decision-makers’ attitudes and awareness regarding the national guidelines for psychosocial interventions targeting people with schizophrenia. Method A questionnaire distributed by e-mail to 592 Swedish decision-makers was analysed using descriptive and comparative techniques. Results Significantly more of the top-level mental health-care managers than politicians stated that they knew about the national guidelines (i.e. their release and content) and they considered the guidelines to be a good source of support for planning and allocating resources. Conclusion If those responsible for allocating resources (i.e. politicians) are unaware of the dissemination of national guidelines or their content, and they do not perceive the national guidelines to be a good source of support for planning and allocating resources, this is likely to have a negative influence on the remit of nurse managers as well as nursing practice. Implications for nursing management Top-level mental health-care managers have a vital role to play in the implementation of national guidelines. However, our findings indicate that implementing national guidelines in practice could be virtually impossible without strategic government support. Keywords: attitude, electronic survey, evidence-based practice, guidelines, mental health