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Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.

A real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.

The integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.

This case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

Drawing on the conservation of resources (COR) theory, this study aims to assess the moderating effect of the psychological contract (PC) type (relational, transactional and balanced) on the relationship between psychological contract breach (PCB) and organizational citizenship behaviours (OCBs).

The authors administered a survey to a sample of 159 nurses working in a large public hospital. To analyse the survey data, the authors used partial least squares with SmartPLS v.3.3, a variance-based structural equation modelling technique that combines principal component analysis, path analysis and regression analysis.

This study shows that nurses counteract the loss of resources following a PCB by investing more in stronger interpersonal relationships with co-workers and patients as a way to recuperate from resource loss and gain social resources. In addition, the moderating effect of the PC type reinforces the relationship between a PCB and OCB in a way that relational and balanced PC types support OCB-I positively but negatively OCB-O. Furthermore, the transactional PC does not reinforce negatively the link between PCB and OCB-I, and the negative interacting effect on the PCB and OCB-O link is only partially supported.

The study findings are grounded on a cross-sectional research design and a convenience sampling strategy.

The results highlight the relevance of human resources management practices centred on employee involvement and participatory supervision styles for ensuring OCB display at the workplace.

The results add new evidence to COR theory by highlighting the importance of social resources as a mitigator in the relationship between nurses’ PCB and OCB towards co-workers and patients (OCB-I). Hence, the OCB-I display will vary in function of the target and the moderating effect of PC type (relational, balanced or transactional).

This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

This paper aims to examine the interaction between gatekeeping and trust in a public sector organization, where employees at lower hierarchical levels are expected to autonomously translate and transform directives into public services. This requires them to have access to operational steering information, i.e. information about directives and how to interpret and apply them. This study focuses on how gatekeeping structures regulate flows of operational steering information and how the gatekeeping structures affect the development of trust.

The research design is qualitative. The data material consisted of semi-structured interviews with 26 employees in home care and schools and of eight complementary nonparticipant observations. Thematic analysis revealed the presence of static and dynamic gatekeeping structures, which are characterized by fixed and variable arrangements of information sources and channels, respectively.

In static gatekeeping structures, managers or domain experts typically act as gatekeepers, and employees also perform gatekeeping activities collectively. Gatekeeping structures allow employees to switch between acting as gatekeepers and being gated, depending on the situation. The results show that gatekeeping structures for intermediation of operational steering information may support or impede employees' work, thus affecting their trust in their peers and their work organization.

Although the present study included both interviews and observations, these primarily occurred within scheduled and prearranged activities rather than capturing the nuances of the typical daily work of teachers and home care employees. As a result, certain perspectives may have been unintentionally omitted.

The participants were recruited through the City of Oslo contact people, which may have impacted their status or perception in some way. Moreover, the study was conducted in the City of Oslo, a specific organization with its own unique set of values, norms and processes. The trust-based management in the City of Oslo is likely not representative of all public sector organizations.

This study contributes conceptually by introducing gatekeeping structures and operational steering information and empirically by providing evidence of their relationship to trust development in public service delivery. Thus, it contributes to the research fields of information management and public administration.

The purpose of this chapter is to examine the budgeting process in a local church from a social capital perspective. The social capital provides novel insights into the construction of budgets and its social aspects. A qualitative case study was adopted, with an interpretive methodology. Semi-structured interviews were used to interview 14 managers involved in the budgeting process at a local independent church. The interview data were supplemented by documentary evidence. Nahapiet and Ghoshal (1998) framework of social capital was used to analyse the data. The main finding was that budgeting was found to be a social process – that can best be explained by social capital theory. There may be an element of self-selection, as the church agreed to participate in the study and chose to allow a researcher to examine social aspects of its budgeting process. The chapter contributes to both social capital theory and church literature. Social capital provides novel insights into the construction of budgets and its social aspects. In addition, contemporary budgeting practices are studied in a church in a denomination and country not previously studied.

While the main emotional labor strategies are well-documented, the manner in which professionals navigate emotional rules within the workplace and effectively perform emotional labor is less understood. With this contribution, I aim to unveil “the good, the bad and the ugly” of emotional labor as a dynamic theatrical performance.

Focusing on three geriatric long-term care units within a French public hospital, this qualitative study relies on two sets of data (observation and interviews). Deeply rooted within the field of study, the chosen methodological approach substantializes the subtle hues of the emotional experience at work and targets resonance rather than generalization.

Using the theatrical metaphor, this research underlines the role of space in the practice of emotional labor in a unique way. It identifies the main emotionalized zones or emotional regions (front, back, transitional, mixed) and details their characteristics, before unearthing the nonlinearity and polyphonic quality of emotional labor performance and the versatility needed to that effect. Indeed, this research shows how health-care professionals juggle with the specificities of each region, as well as how space generates both constraints and resources. By combining static and dynamic prisms, diverse instantiations of hybridity and spatial in-betweens, anchored in liminality and trajectories, are revealed.

This research adds to the current body of literature on the concept of emotional labor by shedding light on its highly dynamic and interactional nature, revealing different levels of porosity between emotional regions and how the characteristics of each type of area can taint others and increase/decrease the occupational health costs of emotional labor. The study also raises questions about the interplay of emotional labor performance with the level of humanization/dehumanization of elderly people. Given the global demographics about an aging population, this gives food for thought at a social level.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.