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This study included qualitative data.
n = 8 (residential eldercare facility setting).
Individual interviews and a focus group. Full details were provided in the project report (ACT Government 2005)
n = 5 (community), n = 4 (acute hospital).
|The study was undertaken in Australian Capital Territory, which, in common with other Australian states and territories, is developing the Nursing Practitioner (NP) role||The findings demonstrated a significant improvement in client outcomes as a result of the implementation of a transboundary nurse practitioner model for the care of older persons. The improved outcomes were associated with a decrease in acute hospital admissions for residential care clients, timely intervention for a range of common conditions and strengthened multidisciplinary approaches to care provision for elderly persons|
2. Duncan and Reutter (2006)
|Qualitative study|| |
Thematic, comparative, critical analysis
|The subsystem of home care within a regional health system during the period 1993–2001||The critical analysis revealed that the emerging policy agenda in regional home care is one of medicalization, which is contrary to primary care principles and potentially leads to further marginalization of the most vulnerable. This contradiction is characterized by conflict with the fundamental values of equity and efficiency, choice and universality, as well as public vis-à-vis individual responsibility for the provision of care|
3. Henriksen and Rosenqvist (2003)
|Qualitative study|| ||Political municipal chairpersons and managers responsible for the care of older persons, in addition to the chairperson, vice-chairperson and executive manager of the north-western sector of greater Stockholm participated in the study||The differing ways of understanding elder care services led to a complex and fragmented organisation lacking clear goals, structures and leadership. However, the authors found a willingness among the respondents to collaborate with each other, as well as indications of positive attitudes towards improving home care/healthcare, domiciliary and nursing care of older people|
4. Henriksen et al. (2003)
|Qualitative study|| ||Municipal managers and politicians, two local county council representatives and health care organisation managers||The main result was that all participants agreed on four key visions of healthcare for the elderly: see the person, see her/his resources, see the encounter, and see yourself. Other findings indicated that (1) care of older persons was governed by diverse interests, (2) the organisation lacked clear leadership and comprehensive goals, (3) the organisation was fragmented and (4) there was a lack of skilled staff members to meet patient needs. Older persons were regarded as passive recipients of care or as objects that did not play an active role in health care decisions that affected them|
5. Johansson et al. (2007)
|Qualitative study|| ||The study was conducted at a nursing home unit in Sweden. The staff comprised 22 assistant nurses/nurse's aides, nine nurses and one-first-line nurse manager||The results indicated that the first-line nurse manager had three goals; (1) A nursing goal that she strongly adhered to and demonstrated excellent control, (2) an administrative goal that she adhered to and exhibited control, (3) a leadership goal that she did not accept and where she had no control. The administrative and leadership goals were based on her job description, but the nursing goal was personally chosen on the basis of self-reflection and goal-fulfilment|
| ||Qualitative study|| |
Interpretative phenomenological analysis
|A 6-month cooperative approach was used to develop insights into the leadership strategies of Consultant Nurses working in the care of older persons and involved the five authors and four Consultant Nurses. The main author was a Consultant Nurse and practice based researcher from a different nursing area||Two key themes emerged relating to complexity and pathways, which provided a major focus for the Consultant Nurses’ leadership role. The outcome of the study is a framework that describes the triggers and enabling factors that precede the use of leadership strategies at clinical and organisational levels as well as the results achieved|
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The study was one of nine implementation projects to evaluate evidence-based change in nine health care settings south of the Thames
|This paper draws on descriptive and qualitative data and addresses the links between contextual issues and the processes and pathways of change. Key themes were: Working through others and across boundaries and Managing uncertainty and unanticipated challenges. Ward staff adherence to the multidisciplinary assessment guidelines was high, with evidence of some dissemination to community staff at follow-up. Three years after the project finished, multidisciplinary assessment still formed part of routine clinical practice|
8. Smith Higuchi et al. (2002)
| || ||A small urban home care office in southern Alberta, Canada employing home care nurses who are responsible for the care of approximately 700 clients and their families||The findings indicated that the decision-making challenges in home care practice comprised four major categories: The development of client-centred care plans: The home care practice environment: Developing confidence in clinical decision making: and ethical decision making|