Mid Sweden University

Objective: The objective of this study was to present challenges and opportunities associated with using Grounded Theory as a study design in the context of a complex intervention.

Data and Method:This study formed part of a larger project exploring the feasibility of applying the Magnet model in nursing homes. Initially, the aim was to understand how registered nurses experience working in nursing homes and what enables them to thrive in their role. Data were collected through open sampling of individual interviews with thirteen registered nurses, complemented by two workshops and one questionnaire. Thereafter, theoretical sampling guided further data collection through interviews with unit leaders and medically responsible nurses, and finally through empirical observations. The analysis followed the principles of open and focused coding, constant comparison, and theoretical coding.

Discussion of Method: Grounded Theory proved particularly suitable for exploring complex and dynamic processes within this intervention. The method allowed flexibility in data collection and analysis, enabling an emerging understanding grounded in participants’ perspectives. A key opportunity was the iterative sampling process, which facilitated theory generation across multiple data sources. One methodological challenge, as often encountered in Grounded Theory, was the process of theorizing—lifting the analysis from descriptive patterns to theoretical abstraction. 

Findings: The resulting theory revealed the main concern, Moral Commitment to Good Care, challenged by structural constraints and perceived gaps in competence among the care staff working most closely with older persons. The core category Sustaining Professional Integrity within a Community of Practice explains how nurses preserve their moral commitment and professional identity through collegial belonging and adaptive strategies amid systemic constraints. The findings illustrate both the practical value and the methodological complexity of applying Grounded Theory within multifaceted healthcare interventions. The method proved particularly suitable for explaining what enables registered nurses to thrive in nursing home settings. 

Objective: The objective of this study was to present and apply a sequential mixed-methods research design aimed at exploring and enhancing teamwork in a nursing home context. Data and Method: This study was part of a larger research project examining the implications of implementing the Magnet model in nursing home settings. A sequential mixed-methods design was employed, combining quantitative and qualitative data collection to deepen the understanding of teamwork and how teamwork might be enhanced. Initially, 41 assistant nurses from two nursing home departments completed a survey measuring six teamwork factors. The survey results then formed the basis for two workshops held between November and December 2024. Each workshop began with a presentation of the survey results. Thereafter, participants reflected individually on what good teamwork between professionals meant to them and documented their thoughts in personal workbooks. The participants then discussed these reflections in smaller groups, documenting shared insights and identifying initial steps toward enhancing interprofessional teamwork. Each group’s reflections were presented in plenary, followed by a concluding collective discussion. Discussion of Method: The sequential design allowed the quantitative findings from the survey to be not only validated but also deepened through qualitative dialogues and collective sense-making. In this way, the workshops functioned as reflective arenas. The design fostered a participatory process that emphasized collaboration and co-creation of value. Results/findings: The survey findings indicated a need to enhance learning between teams across different nursing home units. This issue was further deepened in the workshop reflections, where participants emphasized the importance of being more attentive and responsive, and of making better use of the available knowledge and competence. For example, learning by observing colleagues in practice. The sequential mixed-methods design proved valuable in bridging measurement and meaning, allowing participants’ reflections to enrich and contextualize the quantitative results. 

Title 

Facilitating self-reflection through a questionnaire in residential care settings

Objective

The purpose of this study was to examine how a questionnaire influences care staff’s perceptions of their workplace and patient safety culture.

Background

In Sweden, work in residential care facilities is mainly performed by assistant nurses and care aides. Registered nurses have a supervisory role, but their numbers are limited, and they may be located outside the care units. Organisational complexity arises from the dual governance of municipal care: nurses are regulated by the Health and Medical Services Act, while care staff are governed by the Social Services Act.

Method

Within a project based on the Magnet model to enhance patient safety and care quality, the NHSOPS-S questionnaire was distributed to 165 care staff at five residential care facilities in northern Sweden. Two open-ended questions — “Please provide comments about patient care and patient safety at this facility” (122 responses, 74%) and “Did you find any of the questions difficult to answer?” (108 responses, 65.5%) — were analysed to explore how the questions influenced participants’ perceptions of their workplaces.

Results

Most comments reflected positive experiences of patient safety, highlighting good communication, competence, and long experience within teams. Others described inadequate collaboration, staffing shortages, and poor delegation practices. Insufficiently reasoned risk assessments and care shortcuts due to staff shortages were noted. The division between the Health and Medical Services Act and the Social Services Act was seen as a barrier to communication between nurses and care staff. The questionnaire’s clarity encouraged reflection on work situations. Most found the language easy to understand, though some felt the questions mainly addressed staff in close contact with residents.

Discussion

Questionnaires assessing patient safety culture provide valuable insight into organisational quality. Quantitative items allow comparisons across units, while open-ended questions promote reflection and identify opportunities for improvement in residential settings.

Bakgrund: Svensk sjuksköterskeutbildning omfattar 180 högskolepoäng, motsvarande tre år. Studenter genomför 50% av utbildningen som verksamhetsförlagd utbildning (VFU) enligt EU-direktiv och Högskoleförordningen. VFU inleds redan under första terminen. Vid Mittuniversitetet genomför studenter i termin 2 fyra veckors VFU vid särskilda boenden, i en fas där de utvecklar förståelse för sjuksköterskerollen. Det finns begränsad forskning om hur VFU vid särskilda boenden påverkar studenters beredskap inför och inställning till arbete inom äldreomsorgen efter examen. Syfte: Att undersöka hur sjuksköterskestudenter upplever VFU-processen och handledningskultur vid särskilda boenden. Metod: Semistrukturerade intervjuer genomfördes med elva sjuksköterskestudenter och analyserades enligt reflexiv tematisk analys inspirerad av Braun och Clarke. Resultat: Utifrån ett positivt perspektiv upplevdes VFU vid särskilda boenden som givande. Ett välkomnande bemötande från hela arbetslaget skapade en positiv grund för lärande. Handledande sjuksköterskor uppfattades som professionella och kontinuerlig reflektion bidrog till förståelse för hur de boendes behov tillgodosågs. Studenterna beskrev goda möjligheter att arbeta strukturerat med hög patientsäkerhet och att ta egna initiativ. Peer learning stärkte självständighet och lärande, bland annat genom att studenterna gavs möjlighet att undervisa i arbetslaget. Diskussion: En stabil handledningskultur med utrymme för delaktighet och reflektion framstår som central för att VFU ska bidra till beredskap inför framtida yrkesval. Peer learning kan vara en modell som stärker professionell utveckling genom utbildningen. Slutsats: En välfungerande team- och handledningskultur bidrar till att särskilda boenden uppfattas som attraktiva arbetsplatser och kan stärka studenters intention att återvända efter examen.

Objective: The aim of this abstract is to describe how storytelling and visualization, through a narrative analysis approach, have been used to create a common baseline. Data and Method: This study is part of a three-year research project titled “Develop Leadership and Teamwork at Nursing Homes for Increased Nursing Quality”, funded by the Kamprad Family Foundation. A nursing home manager was asked to reflect on key events and milestones from the past eight years that had influenced the development of the nursing home. During a workshop with two researchers and the manager, these events and milestones were organized into a timeline using post-it notes on a board to visualize the chronological development in the nursing home. The timeline was documented and sent to the manager for verification and adjustments. The final version was presented to the management team for further validation and discussion and subsequently shared with all coworkers at the nursing home. This process aimed to engage staff members, provide a shared understanding of the nursing home’s development, and create a common baseline for continued improvement. Discussion of Method: Storytelling and visualization enabled the manager, management team, and coworkers to better understand and reflect on the nursing home’s history and development. The methods gave researchers a quick overview of the organizational context, revealing both opportunities and challenges for future work. By combining narrative and visual elements, the approach strengthened reflection, dialogue, and collective learning. Results/Findings: The outcome was a timeline that visualized key events and milestones in the nursing home’s recent history. This visualization has helped establish a common baseline and fostered a shared understanding of the organization’s progress, supporting ongoing efforts toward sustainable working conditions and improved quality of care.

Purpose: To explore the concept of nursing homes as attractive workplaces perceived by staff and interpreted through the lens of the Magnet Model®.

Methodology: Two workshops with staff from two departments at a nursing home and one workshop with registered nurses, occupational therapists and physiotherapists were held to explore attractive workplaces. Additionally, interviews were conducted with 12 registered nurses, occupational therapists and physiotherapists in another municipality. For the analysis, the authors combined all of the text from the workshops and the interviews and analysed it versus the five core components from the Magnet Model®: 1) transformational leadership, 2) structural empowerment, 3) exemplary professional practice, 4) new knowledge, innovation, and improvements, and 5) empirical quality results as a deductive frame of analysis.

Findings: The analysis revealed how the staff perceived nursing homes as attractive workplaces through the lens of the Magnet Model®. When sorting the material versus the five core components, all the components contributed attractive workplace examples even though innovation and improvements had the fewest examples and empirical quality results the second least.

Research limitations/implications: This study was limited to staff from one nursing home and all registered nurses, occupational therapists and physiotherapists in another municipality. Further research can be conducted at several nursing homes to explore their view of attractive workplaces. 

Originality/Value: The originality of this research is the use of the Magnet model to analyse an attractive workplace in nursing homes within a municipality context.

Purpose of the paper: To elaborate on the idea that process management (PM) must be infused with a quality culture (QC) to function and reach expected performance targets. The framework of change-driven process management (CDPM) (Cronemyr et al., 2024) has been used in modern and comprehensive PM. Behaviours supporting long- and short-term action and development (Cronemyr et al., 2017; Mårtensson, 2022) have been used as the frame for QC. The purpose of this study is to investigate where and how certain behaviours relate to different PM scenarios. Furthermore, the roles of other behaviours not mentioned in this framework are investigated with respect to successful PM.

Methodology: The paper is based on previous research and deductive discussions among the three authors.

Main Findings: The CDPM framework is defined by four scenarios differentiated by two dichotomies: stability vs. change and control vs. creativity. Two of the scenarios, traditional PM and trust-based PM, are characterised as stable; however, the first is governed more by control and the second more by creativity. Traditional PM is sometimes ‘slow and rigid’, whereas trust-based PM is more ‘free and creative’. However, trust-based PM can sometimes lead to greater process variation, tampering and unpredictable results. The analysis reveals that long-term behaviours are more common in traditional PM, whereas short-term behaviours are more common in trust-based PM. Both types of behaviour may be ‘effective’ in the appropriate circumstances; otherwise, the opposite behaviour may be recommended.

Practical implications: This study reveals how different behaviours characteristic of a quality culture can support organisations in implementing and working with PM.

Originality/value: PM and QC are well-researched areas within quality management; however, the intersection of these areas requires further investigation and development.

Aim To explore how chief nursing officers perceive and enact their leadership within bureaucratic healthcare systems, with a particular focus on patient safety, strategic responsibilities and the advancement of nursing care quality.Methods A qualitative study design was used. Semistructured interviews were conducted between October 2023 and May 2024 with nine female Chief Nursing Officers, representing diverse regional healthcare settings across Sweden. The interviews were analysed using reflexive thematic analysis, which was informed by the theory of bureaucratic caring to support interpretation.Findings Chief nursing officers described navigating hierarchical and bureaucratic systems while promoting person-centred care and professional governance. Their work involved balancing strategic mandates with ethical imperatives, advocating for workforce development and fostering a culture of proactive safety. The analysis generated four interrelated themes: (1) grappling with complexity and power structures; (2) guided by ethics, compassion and purpose; (3) empowering the nursing workforce to provide improved care; and (4) shaping quality care through innovation, evidence and technology.Conclusion Chief Nursing Officers can act as key agents of transformation at the intersection of structure and care. Their leadership extends beyond administrative functions to encompass strategic influence, ethical advocacy and system-level improvement. The findings underscore the need to further formalise and institutionalise the role, ensuring it is equipped with the mandate and structures required to lead across organisational levels. Strengthening such roles calls for leadership models that foster collaboration, support shared governance and enable flatter organisational hierarchies-structures designed to enhance participation, distribute decision-making and promote professional autonomy.Reporting Method This study followed reporting standards for qualitative research by adhering to the EQUATOR Network guidelines and using the COREQ checklist.Patient or Public Contribution Only health care staff participated in this study.Implications for the Profession and/or Patient Care This study highlights the strategic, ethical and relational dimensions of chief nursing officers' leadership and its impact on patient safety, quality improvement and workforce development. The findings demonstrate that they can play a pivotal role in embedding ethical perspectives into healthcare leadership-bridging professional nursing values with structural and strategic priorities. This underscores the importance of enabling nurses to shape care systems in ways that promote safety, professional governance and person-centredness.

Bakgrund

Arbetstiden inom akademin karakteriseras ofta av många och olika arbetsuppgifter samt ständiga avbrott i arbetet. Det gör den akademiska arbetstiden fragmenterad. För att skapa sammanhängande tid avsätter, till exempel medarbetare därför ofta tid i sina kalendrar för olika arbetsuppgifter. Det kan dock leda till suboptimering och en än mer fragmenterad arbetstid för kollegor. Ett sätt att komma till rätta med detta kan vara att enas om kollektiva strategier för hur medarbetare tillsammans kan skapa sammanhängande tid och därmed förbättra sin gemensamma arbetsmiljö.

Syfte

Syftet med studien var att enas om kollektiva strategier för att öka den sammanhängande akademiska arbetstiden och därmed förbättra den gemensamma arbetsmiljön vid en enhet på ett universitet.

Metod

Inom ramen för ett internt projekt med målet om att förbättra arbetsmiljön,så träffades lärare och forskare vid en enhet på ett universitet vid tre tillfällen för att diskutera kollektiva strategier för en ökad sammanhängande arbetstid. Träffarna, i form av workshoppar faciliterades av två projektmedlemmar från det interna projektet och genomfördes enligt följande:• I workshop 1 fick medarbetare, både individuellt och i grupp, reflektera utifrån frågeställningarna: Vad ser du för orsaker till fragmentisering? och Hur gör du för att skapa sammanhängande tid? Reflektionerna skrevs ned på post-it lappar som sattes upp på en vägg och diskuterades. Därefter kategoriserade de två projektmedlemmarna post-it lapparna och gav kategorierna övergripande rubriker.

• Workshop 2 genomfördes i hybrid format och utgick från resultatet från workshop 1. Syftet var att tillsammans i arbetsgruppen identifiera och prioritera kollektiva strategier för att skapa gemensam sammanhängande arbetstid. Medarbetarna delades upp i tre grupper. Inom varje grupp prioriterades först, enskilt och sedan i grupp, de tre viktigaste kollektiva strategierna från workshop 1. Övningen genomfördes på en digital arbetsyta i Mural.• Workshop 3 utgick från resultatet från workshop 2 samt från en enkät som medarbetarna besvarat gällande teamarbetet i arbetsgruppen. Syftet med workshopen var att identifiera gemensamma spelregler och kollektiva strategier för att skapa gemensam sammanhängande tid. Varje medarbetare fick visualisera och skriva ned en eller flera spelregler för att skapa gemensam sammanhängande tid (kollektiva strategier). Medarbetarna berättade sedan om sina bilder. Berättelserna noterades också på post-it lappar och sattes upp på en vägg i workshoplokalen. Workshopen avslutades med att deltagarna gemensamt enades om två spelregler som arbetsgruppen kunde börja tillämpa direkt. 

Resultat

Resultatet från workshoparna var flera, dels bidrog diskussionerna från workshoparna till en ökad insikt och förståelse för varandras arbete, dels till ett antal konkreta gemensamma spelregler och kollektiva strategier som arbetsgruppen kunde börja tillämpa för att skapa gemensam sammanhållen arbetstid. Workshopparna mynnade också ut i ett arbetssätt för hur arbetsgruppen kan arbeta för att öka den gemensamma sammanhängande tiden. Ett arbetssätt som kan vara möjligt att använda även i andra typer av verksamheter för att minska fragmentering av arbetstid.Nästa steg för arbetsgruppen blir att tillämpa och utvärdera hur de kollektiva strategierna påverkat den gemensamma arbetsmiljön.