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Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

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.

The aim of this research is to provide insight into how organizations can co-create value with family members engaged in service journeys of customers experiencing vulnerabilities, thereby paying attention to their organizational practices (i.e. recursive or routinized patterns of organizational actions and behaviors).

To investigate, this research relies upon a multiple case study in a group of nursing homes in Flanders that had the ambition to engage family members in service journeys of their loved ones while measuring their value perceptions as a performance indicator (here, satisfaction with nursing home services).

The case evidence shows that nursing homes co-create value with family members through caring practices that focus on their role as secondary customers (i.e. welcoming, connecting and embedding) and empowering practices that focus on their role as partial employees (i.e. teaming up, informing and listening practices). However, the way in which the different caring and empowering practices are enacted by the nursing home and its staff affects their value co-creation potential.

By focusing on the practices with which organizations can co-create value with family members engaged in service journeys of their loved ones, this research bridges the service literature with its attention for value co-creation practices and the literature on customers experiencing vulnerabilities with its focus on extended customer entities.

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.

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.

This study aims to analyze the structure of publications on transformational leadership in nursing and determine its evolution process through a bibliometric analysis.

It is a descriptive bibliometric study. Data were collected on October 24, 2022, from the Web of Science and analyzed using Excel, VOSviewer, HistCite and Bibliometrix R programs.

A total of 348 studies conducted by 962 authors and published between 1990 and 2021 were included. It was found that 84.5% of these publications were original articles and 97.7% were published in English. The studies are from 82 different journals and were carried out by researchers from 43 countries. The most productive country was the USA (n = 151).

Only one database was used to search for studies. The searches were limited to the nursing category, and only studies published up to 2021 were included. Another important point is that, although there were no language limitations for the field literature search, English keywords were used; thus, the search can be considered semi-limited. It is believed that more comprehensive search strategies may generate different findings.

Two main themes were identified as the studies carried out in the field of transformational leadership in nursing, generally, directly or indirectly addressed the effects of this style of leadership either on nurses’ performance/job satisfaction or on quality care/patient safety; however, a gap was observed in the literature in the area of nursing education. Researchers can be inspired by the results of the present study, by learning about the focus of published research on transformational leadership, which will encourage them to plan new studies to improve nursing education, nursing care, nursing management and working conditions of nurses. Through the results of this study, it is also possible to learn about countries and researchers for possible collaborations in future studies.

Despite the large number of Indonesian health-care workers working as migrant care workers in Japan, there is a lack of studies that have investigated this phenomenon or assessed the working conditions of Indonesian care workers working in Japanese aged-care facilities. This study aims to explore the work experiences of Indonesian care workers in Japan.

A qualitative descriptive research design was used, and a purposive sample of 18 Indonesian health-care workers (12 nurses and six midwives) who work as care workers in Japan participated in this study. Semistructured interviews were conducted with these participants between December 2022 and January 2023. The data were analyzed using content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report this study.

Four key themes emerged from the data: easy but mentally challenging, being a care worker is a blessing, working in a partially Muslim-friendly environment and enjoy living: prefer to stay longer.

The work experiences of Indonesian care workers in Japan are complex and multifaceted. By understanding their experiences and needs, the authors can work toward creating more inclusive and supportive workplaces for all.

Research-based knowledge on homecare nursing is scarce and further information is warranted about citizens’ perceptions of receiving home care under existing conditions. The purpose of this study was to investigate citizen experiences with health-care professionals in the time allotted for home care.

A questionnaire survey was distributed to 348 citizens receiving home care. The questionnaire consisted of questions whether the citizens experienced that enough time was available during the homecare visit and how the conversation and care relationship with the health-care professionals were experienced. The differences in responses were analysed using Fisher’s Exact Tests.

Overall, 94% of the citizens reported that sufficient time had been available and that care relationship and conversation with the health-care professionals had been positive during the homecare visit. However, the findings indicated that citizens aged more than +76 years and citizens with a high educational level were more prone to report that the nurses did not spend enough time during the home visit.

The findings offer useful insights for the professionals in delivering appropriate home care. Listening to citizens’ wishes and needs for home care could lead to better individualised care. Especially the youngest and oldest of the citizens seem to have specific experiences that call for further investigation.

In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for physicians while practicing patient-centered medicine and controlling health-care costs. This paper aims to examine the effect of task shifting to nurses and discuss its usefulness from the perspective of health-care value co-creation.

This paper analyzes task shifting to nurses in acute care hospitals in Japan as a solution for the shortage of anesthesiologists. The authors discuss how the value was created from the perspective of the health-care ecosystem, with conceptual consideration of the value co-creation mechanism through patient-centered practices.

The study showed that task shifting initiatives in Japan can improve the motivation of nurses through human resource development while maintaining high quality. The study also suggested that task shifting from physicians to nurses may contribute to improving net income and maintaining the health-care system.

The findings are highly reproducible and can be immediately applied to initiatives at other medical institutions in Japan. Furthermore, it is suggested that these findings might provide some perspective on the realignment of fragmented healthcare in the USA.

It was confirmed in practical terms that micro-level initiatives have an impact on the macro level as well. In addition, the academic presentation of the concept has contributed to the deepening of value research.

This study aims to appraise and synthesize evidence examining the effects of toxic leadership on the nursing workforce and patient safety outcomes.

This is a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases (SCOPUS, PubMed, Web of Science, CINAHL and Psych INFO) were searched to identify relevant articles. Two independent researchers conducted the data extraction and appraisal. A content analysis was used to identify toxic leadership outcomes.

The initial literature search identified 376 articles, 16 of which were deemed relevant to the final review. Results of the content analysis identified 31 outcomes, which were clustered into five themes: satisfaction with work; relationship with organization; psychological state and well-being; productivity and performance; and patient safety outcomes. Seven mediators between toxic leadership and five outcomes were identified in the included studies.

Organizational strategies to improve outcomes in the nursing workforce should involve measures to build and develop positive leadership and prevent toxic behaviors among nurse managers through theory-driven strategies, human resource management efforts and relevant policy.

The review findings have provided modest evidence suggesting that working under a leader who exhibits toxic behaviors may have adverse consequences in the nursing workforce; however, more research examining if this leadership style influences patient safety and care outcomes is warranted.