Kristina Westerberg

Toward Understanding the Direct and Indirect Effects of Transformational Leadership on Well-Being A Longitudinal Study

In this two-wave longitudinal panel study, the authors strived to advance understanding of how transformational leadership affects employee well-being over time. The authors proposed a model that included both direct and indirect effects, which was tested in a sample of social service employees. Results of structural equation modeling revealed that transformational leadership had no direct effect on well-being over time. Instead, both the short-term and long-term effects of transformational leadership on well-being were mediated by a positive climate for innovation. The study contributes to knowledge about the complicated processes by which leaders influence well-being of employees.

Learning Climate and Work Group Skills in Care Work.

Purpose – The overall aim of the present study was to investigate the learning climate and work group skills perceived by managers and their subordinates in the municipal elderly care, prior to a d ...

Municipal middle managers: psychosocial work environment in a gender-based division of labor

The purpose of the reported study was to explore how 245 municipal middle managers perceived their psychosocial and physical work environments, and to examine psychosomatic reactions and job satisfaction in departments engaged in different types of activity, also to compare male and female managers in these respects. The way in which psychosomatic reactions and job satisfaction were related to the psychosocial and physical work environments was also investigated. The results indicated a difference between departments depending on the type of activity. Departments concerned with care and education, i.e. care of the elderly, child care and schools showed a tendency to lower values for psychosocial work environment factors and more psychosomatic reactions than the departments geared more towards maintenance and production, i.e. street maintenance, the power plant department and the recreation office. In the departments concerned with children female managers were in a majority. In the street maintenance department, the recreation office and the power plant department, male managers predominated. Compared to the men, the women had a higher level of education, lower salaries, more reactions of a psychosomatic nature, lower job satisfaction and a less satisfying psychosocial work environment. The only department with an equal number of male and female managers was the schools department. Here there were no differences between men and women in the factors studied. Two partial correlations were computed in order to separate the importance of type of activity and sex to the work environment factors and outcome variables. This indicated that the type of activity was more important than biological sex. The gendering of work activities is therefore also discussed and further investigations are suggested.

The importance of leadership style and psychosocial work environment to staff-assessed quality of care: implications for home help services

Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross-sectional survey design was used and a total of 469 questionnaires were distributed (March-April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.

History and Conflicting Themes in a Gender Creating Culture

In this article statements made by elder care middle managers containing explanations of conflicts and tensions during a period of change in two municipalities are described and related to the history of the work activity. Furthermore, the explanations are associated with the construction of gender in this type of work activity. The results show that it is possible to relate different perceptions of work conflicts and various constructions of femininity to the history of the work. The use of cultural-historical and activity theory approaches on gender and management is discussed and a concept of activity identity is suggested.

The Meaning of a Knowledge-based Organization in Swedish Municipal Elderly Care

This article addresses the notion of the knowledge-base in a Swedish social services organization. The overall aim was to investigate the concept of a ‘knowledge-based organization in municipal elderly care’ as it was perceived by informants at different organizational levels and professional and political functions in the social services. The research questions concerned how different informants perceive, and to what extent they share, the meaning of a knowledge-based organization and to relate these perceptions to the organizational conditions for learning and knowledge use. The theoretical point of departure was the socio-cultural approach where the interaction between communication, cultural artifacts and actions are important ingredients. The results showed that there were different views on the meaning of knowledge-based elderly care, mainly related to professional functions and organizational levels. It is argued that these views have implications for organizational learning and change as well as formal training and education.

The impact of elderly care competence and quality improvement programme in four Swedish municipalities

During a number of years Swedish municipalities have work with improvment of competence and long-term quality in elderly care. The overall aim of the present study was to compare different learning activities (workplace improvement and/or courses), and to relate these activities to learning climate, learning strategies, and perception of care quality. In addition, the effect of organisational changes was tested. Four Swedish municipalities were selected and 219 nursing assistants filled in a questionnaire (response rate, 58%). Documentation of the learning activities was collected. A two-way multivariate analysis of variance was computed to answer the research questions. The results showed that there was a main effect for learning activities and organisational change on learning climate and learning strategies, but not on the perception of care quality. A combination of courses and workplace improvement practices yielded better results compared with only one of these activities, and organisational changes had a negative effect. The results suggest that the workplace should not only be regarded as an area for non-formal training but should also be included as a part of a training programme. Organisational changes should be avoided during the programme, otherwise the expected effects of the time and effort invested may be wasted.

“The balancing act”— Licensed practical nurse experiences of falls and fall prevention: a qualitative study

BackgroundFalls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients.MethodsA qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis.ResultsThe result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, “the balancing act”. The theme includes three categories: “the right to decide”, “the constant watch”, and “the ongoing negotiation” as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients’ appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients’ risk of falling and to be active to prevent falls. At the acute ward, the words “risk of falling” were not used and fall prevention were not discussed; instead the licensed practical nurses used for example “dizzy and pale”. The results also indicated differences in components that facilitate workplace learning and knowledge transfer.ConclusionsDifferences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.

Showering is more than resistance : cognitive interview sequences in residental homes for elderly clients with dementia

An interview method, based on the cognitive interview, was used to capture critical work situations in elderly care, in this case showering elderly clients suffering from dementia. Generally, this experience causes clients to become agitated and aggressive. Twelve nursing assistants participated in individual and group interviews. This study explored whether it was possible to distinguish different sequences and themes in the staff descriptions of shower situations. The results were analyzed with a grounded theory approach and showed that it was possible to distinguish seven sequences in the shower situation, each with different themes and with diverse qualities. The themes showed that there were sequences that contained cooperation, participation, and satisfaction. Two sequences were typically met with resistance. This study also comments on the usefulness of the results and the interview method with respect to education planning and clinical practice.

Job crafting, employee well-being, and quality of care

The main objective is to study the effects of job crafting activities of elder care and nursing home employees on their perceived well-being and quality of care in two European countries, Spain and Sweden. The Job Crafting, the General Health, and the Quality of Care questionnaires were administered to 530 employees. Correlations and hierarchical regression analyses were performed. Results confirm the effects of job crafting on quality of care (r = .291, p < .01; β = .261, p < .01; ΔR2 = .065, p < .01) and employees’ well-being (r = .201, p < .01; β = .171, p < .01; ΔR2 = .028, p < .01). A positive linear relationship was found between job crafting and well-being in Spain and Sweden and with quality of care in Spain. On the contrary, in Sweden, the relationship between job crafting and well-being was not linear. Job crafting contributes significantly to employees’ and residents’ well-being. Management should promote job crafting to co-create meaningful and productive work. Cultural effects are proposed to explain the differences found.